HomeMy WebLinkAboutKUBAT EQUIPMENT & SERVICE CO., INC. - INSURANCE CERTIFICATE`
ACORO� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD7YYVY)
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THIS CERTIFICATE IS ISSUED AS A MATFER OF INFORMATIpN ONLY AMp CONFERS NO RIGHTS UPON TFiE CERTIFICATE HOLDER. TH7S
CERTIFiCATE DOES NOT AFFIRMATfVE�Y OR NEGATIVELY AMEND, EXTEND OR A�TER THE COVERAGE AFFORDEp BY 7HE POLICIES BELOW.
THIS CERTIFICATE OF INSURANCE DOES MOT GONSTITUTE A CONTRACT BETWEEfJ THE ISSUING INSURER{S), AUTHOR{ZED REPRESENTATIVE
OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPOR'fANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies} must have ADDITIONAL INSUREQ 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
certiticate does not confer rights to the certificate holder in lieu of such endorsement�s�.
PRODUCER Lockton Compan�es
444 W 471h Street Suite 900 I PNQNE
Kansas City MO 64 7 1 2-1 906 E•MAI_ ��"'�
(816) 960•900G i ADDRE55: �___�_
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kcasu@lockton.com � „� INSURER 5 AFFORDING COVERAGE NAIC p
I iMsuReRn: Zurich Amencan Insurance Company �16535
1NSURED D&H UNIiED FUE�fN:; SOLUTIONS. INC. � v�� � IMSURER B: COIOfI Insurance Com an 39993
4g'i 5O$ KUBkT EQUIPMENi & SERVICE CO., INC. INSURER C: I
12100 CROWN POIIVTE DRlVE, STE 110
SAN ANTONIO TX 78233-5366 INSURER D:
ll15UFiEfi E :
INSURER F : I
COVERAGES CERTIfICATE NUMBER: 18257747 REVISION NUNkBER: XXXXXXX
THIS IS 70 CERTIFY THA7 THE POLICIES OF INSURAiJCE LISTED BELOW HAVE BEEN 1SSUE� TO THE INSIlRtD NAMED ABOVE FOR T}iE POLICY
PERIOD INpICNTED NOTWITFiSTANDING ANY REQUIREMENT, TERM dR CONDITION qF ANY CaN7RACT OR OTHER DOCUMENT WI'H RESPECT TO
WHICH THIS CERTIFICATE MAY BE 1SSU�D OR MAY PERTAiN. THE INSURANCE AFFORDED BY THE POIkCIE5 DESCRIBED NEREIN IS SUBJECT TO
A� TH T RM X I NS AND G.¢NpV,TI�N,�OF U H P LI IES LIMITS HOWN MAY HAV B' N R� Y P I IM
INSR AppL15UBR POUCY EFF � POLICY EXP
LTR IYPE OF IiJSURANC6 INSD IWVD POLtCY NUMBER MM/DOJYYYY . MM7DDIYYYY lIM1T5
B �( COMMERGiAL GENERAL LiABILITY PACE303737 08/07/2 22 IO / OZ EACH OCCURRENCE �
� �4 1, 000.000
I CLAIMS-MADE � OCCUR � A � � 3OO OOO
MED EXP Anv one �So�� �= 5.aao
N N PERSONAL 8 ADV INJUR�' S�I OOO.00O
GeN'L A!+GR�EG�7c LIMIT A^PPLIES PER GEN�RAL AGGREGATE � 2.000.000
POLICY� J( � P� � ' x I �Q� PRODU(:TS - COMPlOP AG:+ I 5 Z.00O OOO
� � l 1
07HER 5
A AUTOMOBILE LIABRITY 3919220-02 �B�O�/ZO22 OSIO7I2O2 � E�a aB�E�D SINGLE UAAIT � f 2 OOO.00O
X ANY AUTO BODILY IN3URY �Per person S XXXXXXX
OWNED X �'CHEDULED N N 80DILY INJURY (Per acGtlent)I ` XXXXXXX
AUTOS ON:Y AUTOS
X AJ OS ONLY AUTOS ONLD (Pe�accRaen�DAMAGE S XXXXXXX
� 5 xXXXXXX
B UMSRELIA LIAB X��cuR v v EXC303738 08107�2�2a�j' �$��%iZOZ��kGN OGCURRENI:� �'� �.Q�0.00p
X EXCESSLIAB ^�AIkS•MhDc N N I AGGREGHTE ���.D��,QaO �
DED I RETENTIONS
c
WORKERS COMPEMSATION X
A AND EMPLOYERS' LIABILITY Y! N 3919219-02 OHIO%I2OZ O$IO%/2023 /�
ANYPROPAIEfOR/PARTNERIE7IECUTIY'i E.i EACIiACCIDEN- � �.00V.00O
OFPiCERrr,nEMB�R EECIUDEU% � I N 1 A N�
IManono.y i� aHi E L �iSE:�SE • E/+ EMPIOvEE `- ti.00fl,O�O
f� ycs tleau�ce u�ae�
OESCRIPTIp1: OF OP�RAT{OHS psloH £_ DISE�Sc � FOL G" LIMi7 � �.00O.00O
QESCRIPTION OF OPERATIONS 7 LOCATIONS ! VEHICLES �ACORII 1D1 AdtlRiOnAI RBmarks Schatlule. may be attached tl more space is reqWredi
RE' 9270 TRANSFORT 3-AXLE BUS IIFT - CITY OF FT COLLINSr TRANSFORT 6570 PORTNER RC FT COLLINS CO 08522 THE INSURANCE EVIDENCED BY
THIS CERTIFICATE WILL NOT REDUCE COVERAGc OR LIMITS AND WILL NO � BE CANCELLED. EXCEPT AFTER THIRTY ;30'� DAYS WRITTEN NO'ICE HAS BEEN
RECEIVED BY THE CfTY OF FORT COLUfvS FOR CAN,�,ELLATION FpR ANY REASON OTHER THAN NONPAYMENT OF PREMIUM THE INSURERiS � W{LL SEND
3Q DAYS NOTICE OF CANCELLATION TO TFiE CERTIFICATE HOLDER
CERTIFICATE HOLDER CANCELLATION
SHOULO ANY OF 7HE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
7HE EXPIRA710N DATE THEREOF. NOTICE WILL BE DELIVERED IN
ACCORDANCE WI7H THE POLICY PROVISIONS.
18257747
CITY OF FORT COLLINS
300 LAPORTE AVE
FT COLLfNS CO 8Q522
AUTHORI2Ep REPRESENTAT�VE
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