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Home My WebLink AboutDAVEY RESOURCE GROUP INC - INSURANCE CERTIFICATE 2023-2024'`�c RD� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) `—� oans�zo2s 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 POLIGIES 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 MARSH USA LLC. NAME: Marsh � U.S. Opera6ons PHONE FAX 200 Public Square, Suite 3760 A/C No X• ($66) 966-4664 ac No : Cleveland, OH 44114-1824 E-MAIL IINSURED Davey Resource Group, Inc. 295 S. Water Street, Suite 300 Kent, OH 44240 COVERAGES �---- ao�rtess: Cleveland.CertRequest@marsh.com INSURER S AFFORDING COVERAGE NAIC # 104250 RESOU RICHA iNsuRea n: Old Re ublic Insurance Com an 24147 INSURER B : . INSURER C : INSURER D : INSURER E : INSURER F : CERTIFICATE NUMBER: CLE-005898632-19 REVISION NUMBER: 4 i r�io io i v tiCR I If T i nr♦ i i r-it r�u�it� ur iNSUKANGE 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. R TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP POLICY NUMBER MM/DD/YYYY MMIDD/YYYY LIMITS � X COMMERCIALGENERALLIABILITY MWZY 314042 23 O9/O1/2023 O9IO1I2O24 EACH OCCURRENCE $ S,OOO,OOO CLAIMS-MADE � OCCUR PREM SES� a occTur ence $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- � JECT � LOC AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED X NON-OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB � OCCUR EXCESS LIAB CLAIMS-MADE MED EXP (Any one person) PERSONAL & ADV INJURY GENERALAGGREGATE PRODUCTS - COMP/OP AGG BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTYDAMAGE $ Per accident $ EACH OCCURRENCE $ AGGREGATE $ A WORKERS COMPENSATION MWC 314040 23 (AOS) 09/01I2024 X PER OTH- AND EMPLOYERS' LIABILITY Y� N STATUTE ER ANYPROPRIETORIPARTNERIEXECUTIVE . OFFICER/MEMBEREXCLUDED9 � N�A E.LEACHACCIDENT $ S,OOO,OOO (Mandatory in NH) E.L DISEASE - EA EMPLOYEE $ 5,��,�0� If yes. describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ S,OOO,OOO A Excess Woricers Compensation MWXS 314043 23 (NC, OH, PA, WA) 09/0112023 09/01I2024 Workers Compensation Statutory A SIR: $5,000,000 MWXS 316391 23 (CA) 09/01I2023 09/01/2024 Employer's Liability 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) THE CITY OF FORT COLLINS IS(ARE) INCLUDED AS ADDITIONAL INSURED(S) AS RESPECTS GENERAL LIABILITY AND AUTOMOBILE LIABILITY WHERE RE�UIRED BY WRITTEN CONTRACT OR AGREEMENT AND ONLY AS RESPECTS OPERATIONS PERFORMED ON THEIR BEHALF BY THE NAMED INSURED. TE CITY OF FORT COLLINS 215 N MASON ST. CITY OF FORT COLLINS, CO 80524 CANCELLA 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 g 25,000 $ 5,000,000 g 5,000,000 g 5,000,000 $ $ 5,000,aoo %l�caz.�lz 2'�C'� �.C�.C.��i ACORD� ��. AGENCY MARSH USA LLC. POLICY NUMBER CARRIER ADDITIONAL REMARK AGENCY CUSTOMER 10: CN101565730 LOC #: Cleveland ADDITIONAL REMARKS SCHEDULE NAMEDINSURED Davey Resource Group, Inc. 295 S. Water Slreet, Suite 300 Kent, OH 44240 NAIC CODE EFFECTIVE DATE: Page 2 of 2 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers Compensation dces not apply in MN. Coverage is obtained from Workers Compensation reinsurance association (W.C.R.A.) as required by the state. Minnesota Employers Liability is covered by policy number MWC 314040 23. ,acoRO� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) `.,� 08I16/2023 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 NAMEACT Marsh � U.S. Operatlons MARSH USA LLC. 200 Public Square, Suite 3760 A��NNo �. (866) 966-4664 Fvc No : Cleveland, OH 44114-1824 qooRess: Cleveland.CertRequest@marsh.com IINSURED Davey Resource Group, Inc. 295 S. Water SVeet, Suite 300 Kent, OH 44240 COVERAGES 104550 RESOU CERTIFICATE NUMBER: INSU INSURER A : Old R@pUbIIC INSURER B : INSURER C : INSURER D : INSURER E : CLE-007037877-02 REVISION NUMBER: 4 NAIC # 24147 i rii5 is i U C:tK I IFY 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. R TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP R POLICY NUMBER MM/DD/YYYY MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY MWZY 314042 23 09/01/2023 09/01/2024 EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE a OCCUR PRF1rA �FcO RENTED ^rQ R Z OOO OOO GEN'L AGGREGATE LIMIT APPLIES PER: �POLICY � PR� � LOC X JECT A AUTOMOBILELIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED X NON-OWNED AUTOS ONLY AUTOS ONLY UMBRELLALIAB � OCCUR EXCESS LIAB CLAIMS-MADE MED EXP (Any one person) PERSONAL 8 ADV INJURY GENERALAGGREGATE PRODUCTS - COMP/OP AGG $ $ $ $ $ 25,000 2,000,000 2,000,000 2,000,000 2�� I.VIVIDIIVCU JIIVI]LC LIMI I $ Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ EACH OCCURRENCE AGGREGATE A WORKERS COMPENSATION MWC 314040 23 (AOS) �9��1�2024 X PER AND EMPLOYERS' LIABILITY Y� N STATUTE ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? ❑N N/A E.L.EACHACCIDENT (Mandatory in NH) E.L. DISEASE - EA EMF If yes, describe under DESCRIPTION OF OPERATIONS below E.L DISEASE - POLICI A Excess Workers Compensation MWXS 314043 23 (NC, OH, PA, WA) 09/0112023 09/01/2024 Workers Compensation A SIR: $5,000,000 MWXS 316391 23 (CA) 09/0112023 09/01/2024 Employers Liability Statutory 1,000,000 DESCRIP710N OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins is(are) included as Addilional Insured(s) as respects General Liability and Automobile Liability where required by written contract or agreement and only as respects operations performed on iheir behalf by the Named Insured. This insurance is primary and non-contributory over any existing insurance and limiled to liability arising out of ihe operations of the named insured where required by written contracf, subject to policy terms and conditions. Coverage includes waiver of subrogation where required by written contract on General Liability, Auto Liability, and Workers Compensation coverage. City of Fort Collins Attn: Purchasing Division P.O. Box 580 Fort Collins, CO 80522 CANCELLA 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 $ $ $ $ $ g 2,��0,�� g 2,000,000 $ 2,00�,0�� z.a� ?7C.S.�'f!T ..G�.G;� ��n rnooneer�.�u .�� ---�. AGENCY CUSTOMER ID: CN101565730 LOC #: Cleveland ACORD� ��. AGENCY MARSH USA LLC. POLICY NUMBER CARRIER ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE NAIC CODE NAMEDINSURED Davey Resource Group, Inc. 295 S. Water Street, Suite 300 Kent, OH 44240 EFFECTIVE DATE: Page 2 of 2 ITHIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers Compensation dces not apply in MN. Coverage is oblained from Workers Compensation reinsurance association (W.C.R.A.) as required by the slate. Minnesota Employers Liability is covered by policy number MWC 314040 23.