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HomeMy WebLinkAboutAcord-3/14/2011 (2)fril L,vtcuM CERTIFICATE OF LIABILITY INSURANCE DATE(M/22011011) 03/100/ 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 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 Elliott Hartman Agency 611 Ansborough Ave. P.O. Box 748 Waterloo, IA 50704 NAMEECT Scott Poppens (NCNN ,Em (319)233-8459 (FC,No): (319)232-0645 ADDRESS: PRODUCER CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # INSURED KWS, Inc.; Cedar River Contracting, Inc. 1125 Lincoln Street Cedar Falls, IA 50613 INSURERA: Travelers Property Casualty Co of America INSURERB: Travelers Indemnity Company 07/15/2010 INSURERC: Phoenix Insurance Company EACH OCCURRENCE INSURERD: DAMAGE TO RENTED PREMISES (Ea occurrence) INSURER E : INSURER F : CLAIMS -MADE COVERAGES CERTIFICATE NUMBER: GL/WC/UMB REVISION NUMBER: 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 TYPE OF INSURANCE SR SUBR POLICY NUMBER POLICY EFF (MM/DDn!YYY) POLICY EXP (MM/DD/YYYY) UMITS C GENERAL X UABIUTY COMMERCIAL GENERAL LIABILITY DT-C0-6561C894-PHX-10 07/15/2010 07/15/2011 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES POLICY PRO- JECT PER: LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS DT810-6516C894-TIL-10 07/15/2010 07/15/2011 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTYDAMAGE (Per accident) $ $ $ B UMBRELLA UAB EXCESS UAB X OCCUR CLAIMS -MADE DT-CUP6561C894IND-10 07/15/2010 07/15/2011 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 X DEDUCTIBLE RETENTION $ 10,000 $ $ WORKERSC MPENABTION AND EMPLOYERS' ANYIPROPRIE ER EXCLNER/ ECUTIVE (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/ N N / A DTJ-UB-6561C894-TIL-10 07/15/2010 07/15/2011 X TORY UAMITS °R- E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 C INSTALLATION FLOATER LEASED/RENTED ITEMS QT6602871C475-PHX-1007/15/2010 07/15/2011 $500,000 LIMIT $100,000 LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule If more space Is required) roject: Contract ID: 07-8155-719 :ity of Waterloo is an additional insured when required in written contract. CERTIFICATE HOLDER CANCELLATION City of Waterloo 715 Mulberry Street Waterloo, IA 50703 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 Scott L. Poppens, CIC ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD