Navigating the complexities of the KPL 410NA form is crucial for non-aerial pesticide applicators in ensuring their businesses are protected and compliant with Kansas state regulations. As a certificate of liability insurance, this form is more than just a piece of paper—it's a testament to a business's dedication to responsibility and safety. By certifying that a business carries adequate insurance, it reassures the community and regulatory bodies of the applicator's commitment to safeguarding against potential damages arising from pesticide use. This insurance not only covers incidents of property damage and bodily injury but also ensures that the applicator's operations do not come to a halt due to unforeseen liabilities. The requirements laid out—ranging from the minimum coverage amounts to the detailed listing of what needs to be included on the certificate—underscore the importance of meticulous adherence to legal standards. Importantly, the form serves as a communication bridge between pesticide businesses, the Kansas Department of Agriculture, and the insurance industry, making certain that all parties are aligned in terms of policy effectiveness and transparency in operations. With stipulations for timely notifications to the Secretary of the Kansas Department of Agriculture about any changes to the policy, the KPL 410NA form embodies a proactive approach to managing risks in the pesticide application industry.
| Question | Answer |
|---|---|
| Form Name | Form Kpl 410Na |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | format of non liability certificate, no liabilities certificate format, non liability certificate in malayalam, non liability certificate malayalam |
Form KPL 410NA (rev 10/2012)
CERTIFICATE OF LIABILITY INSURANCE
FOR
This is to certify that we have issued a business liability insurance policy to:
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Name of Insured Pesticide Business |
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Doing business as name (d/b/a) |
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The insurance liability coverage herein pertains to the use of pesticides, and is separate from, or in addition to any coverage of business vehicles.
The undersigned hereby certifies that liability insurance issued to the above named pesticide business, fulfills the requirements of K.S.A.
(1) Coverage for not less than $5,000 per occurrence property damage liability for damages to real or personal
property that suffer damage as a result of the use of pesticides by the pesticide business or persons working under the supervision of such business. Coverage must be provided to cover “property damage” regardless of the
premises, site or location at which or on which the pesticide use or damage occurred. Property damage deductible $__________.
(2) Coverage for not less than $25,000 per occurrence bodily injury liability for injuries to persons not employed by
the pesticide business, that suffer injury as a result of the use of pesticides by the pesticide business or persons working under the supervision of such business. Coverage must be provided to cover “bodily injury” regardless of
the premises, site or location at which or on which the pesticide use or injury occurred. Bodily injury deductible $__________.
Liability insurance provided in accordance with the above numbered policy is subject to the insurance policy provisions of the company filed with and approved by the Kansas Commissioner of Insurance pursuant to K.S.A.
The insurer agrees to provide written notification to the Secretary, Kansas Department of Agriculture, at least 10 days prior to the effective date of any expiration, reduction or cancellation of the liability insurance. Such notification is to be sent to: Kansas Department of Agriculture, Records Center, Business Licensing Section, 109 SW 9th Street, Topeka, KS 66612. Fax
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(Guidelines for completion follow)
Guidelines
Certificate of Liability for
These guidelines are provided to help in the preparation and submission of acceptable insurance certificates. If these guidelines are followed, it will result in more expeditious handling of insurance certificate matters in connection with Kansas pesticide applicator business license requirements.
The certificate of liability insurance is supplied to you for your use and convenience in meeting licensing requirements as a
matter what form is used the following is required:
1.
a. The insurance coverage must cover damages caused by any pesticides used by the business as follows:
1. For not less than $5,000 per occurrence property damage liability for damages to real or personal property, that
suffer damage as a result of the use of pesticides by the pesticide business or persons working under the supervision of such business. Coverage must be provided to cover “property damage” regardless of the premises, site or location at
which or on which the pesticide use or damage occurred.
2.For not less than $25,000 per occurrence bodily injury liability for injuries to persons not employed by the pesticide
business that suffer injury as a result of the use of pesticides by the pesticide business or persons working under the supervision of such business. Coverage must by provided to cover “bodily injury” regardless of the premises, site or
location at which or on which the pesticide use or injury occurred.
b. K.S.A.
control repel, attract or mitigate any pest and (2) any substance or mixture of substances intended to be used as a plant regulator, defoliant or desiccant.”
2.If the insurance policy specifically excludes a particular pesticide or method of application, the business may not use that pesticide or method of application.
3.To be timely processed, the following information must be included on the certificate of insurance:
The policy number;
The policy’s effective date;
The policy’s expiration date;
The signature (handwritten or stamped) of an authorized representative of the insurance company;
The insurance company’s name, address and telephone number;
The insured’s complete legal name;
The name under which the insured does business (d/b/a); and
The insured’s Pesticide Business License number.
4.The certificate of liability insurance must be executed by an insurance company authorized to do business in Kansas or by a licensed insurance agent operating under authority of K.S.A.
5.NOTICE TO INSURANCE COMPANY - If you do not currently have on file with the Kansas Insurance Department an
Endorsement permitting you to notify the Secretary, Kansas Department of Agriculture, of the expiration, reduction or cancellation of the insured’s policy, please file such endorsement immediately pursuant to K.S.A.
The endorsement should read:
In compliance with K.S.A.
In order that companies will not be in violation of insurance laws, each company must file with the Insurance Commissioner a copy of the endorsement they put on policies.
6.Return the completed Certificate of Liability Insurance to: KANSAS DEPARTMENT OF AGRICULTURE Records
109SW 9th St Topeka, Ks