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Home My WebLink AboutKLM CONSTRUCTION INC - INSURANCE CERTIFICATE (3)ACOR I a CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 09/15/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Advantage 1 Insurance CONTACT NAME: Cheryl Johnson HONNo.E Exti; (320)252-6650 FAX No): (320)252-7536 ADDRESS: info@advantageoneins.com 3801 N 3rd Street INSURERS AFFORDING COVERAGE NAIC# SAINT CLOUD, MN 56303 INSURERA: Midwest Family Mutual INSURED INSURER B : INSURERC: KLM CONSTRUCTION INC. INSURER D : 7000 W 14TH AVE INSURER E: LAKEWOOD, CO 80214 INSURER F : COVERAGES CERTIFICATE NUMBER: 00000000-81691 REVISION NUMBER: 4 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM DPOLI EFF MMLl Y/YYYY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX1 OCCUR CPCO050260184 09/15/2017 09/15/2018 EACH OCCURRENCE $ 1 000 000 _7 DAMAGE PREM SESOEa occu ence $ 50 000 MED EXP (Any one person) $ Excluded PERSONAL & ADV INJURY $ 1,000,000 MLOCGEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PE� OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY X AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY CPC0050260184 09/15/2017 09/15/2018 Ee BINEDtSINGLELIMIT $ 1.000.000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CPCO050260184 09/15/2017 09/15/2018 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED X I RETENTION $ 10000 $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CFRTIFICATE HOLDER CANCELLATION City of Fort Collins PO Box 580 FORT COLLINS, CO 80522-0580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE U 1988-2015 ACORD GUKPUKA 1 IUN. All rlgnts reservea. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Printed by CLJ on September 15, 2017 at 09:41AM