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HomeMy WebLinkAbout210013 KELLYROCK ELECTRIC - COI and WCACORN° CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 04/19/2022 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 CONTACT NAME: Christie Mueller ONE A/CC, N Ext): (303)660-0470 FAx (A/c, No): (303)389-9403 E-MAIL ADDRESS: christie@theyoungig.com INSURER(S) AFFORDING COVERAGE NAIC # Young Insurance 806 S. Public Road #102 Lafayette, CO 80026 INSURERA: State National Insurance Company 12831 INSURED INSURER B: State Auto Insurance Company 25135 INSURER C: Chubb Insurance Company 10052 Kellyrock Electric, Inc. 7340 Kelty TO INSURER D: Liberty Mutual 24074 Franktown, CO 80116-9545 INSURER E'. INSURER F: DAMAGE TO RENTED (Ea occurrence) COVERAGES CERTIFICATE NUMBER: 00010280-376495 REVISION NUMBER: 44 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 INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY NXTM2Y2821-01-GL 10/08/2021 10/08/2022 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE [XI OCCUR DAMAGE TO RENTED (Ea occurrence) $ 100,000 —PREMISES MED EXP (Any one person) $ 15,000 PERSONAL & ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 GEN'L X PRO - POLICY [:] ECT D LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: B AUTOMOBILE LIABILITYMBIED 10030695CA 07/01/2021 07/01/2022(CEO, accclden SINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY X AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED X AUTOS ONLY X AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ `+ WORKERS COMPENSATIONPER AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y /" OFFICER/MEMBER EXCLUDED?N (Mandatory in NH) Y / A 71784374 01/01/2022 01/01/2023 X STATUTE EORH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 D Inland Marine BM063653684 08/12/2021 08/12/2022 Scheduled Equip $64,043 Leased/Rented $25,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION City of Wheat Ridge 7500 W. 29th Ave. Denver, CO 80033 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 t � VA, CAM ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Printed by CAM on 04/19/2022 at 01:05PM