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HomeMy WebLinkAboutATI Restoration, LLC - Insurance Certificate 2022-2024 ---, ® CERTIFICATE OF LIABILITY INSURANCE DATE(/16/20YYYY) ACORO �_- O616/2023 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). .5 PRODUCER CONTACT d NAME: Aon Risk Services Northeast, Inc. P (866) 283-7122 FAX (800) 363-0105 d New York NY office (A/C.No.Ext): (FAX No.): o one Liberty Plaza E-MAIL 165 Broadway, Suite 3201 ADDRESS: _ New York NY 10006 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Everest Indemnity Insurance Company 10851 ATI Restoration, LLC & all subsidiaries INSURERB: Zurich American Ins Co 16535 3360 E La Palma Ave Anaheim CA 92806 USA INSURERC: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570100098718 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. Limits shown are as requested LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYY MM/DD/YYYY EF ML LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE ❑X OCCUR PREMISES Ea ocMA1,E Tocurll rence $1,000,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 c2 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $2,000,000 rn X POLICY PRO- JECT LOC PRODUCTS-COMP/OPAGG $2,000,000 0 OTHER: o n B BAP 4446642 04 08/01/2022 08/01/2023 COMBINED SINGLE LIMIT iO AUTOMOBILE LIABILITY $1,000,000 Ea accident X ANYAUTO BODILY INJURY(Per person) C SCHEDULED Z OWNED BODILY INJURY(Per accident) N AUTOS AUTOS IREDAUOTOSY NON-OWNED PROPERTY DAMAGE v ONLY AUTOS ONLY (Per accident) 1: 0) A X UMBRELLALIAB X OCCUR EFlC000103221 08 01/2022 08/01 2023 EACH OCCURRENCE $10,000,000 U EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 DED RETENTION 8 WORKERS COMPENSATION AND WC444664104 08 O1 2022 08 O1 2023 X PER STATUTE I OTH- EMPLOYERS'LIABILITY Y/N ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? Y N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If as,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000—_ A Contractors Pollution EF1ML00149221 08/Ol/Z02Z 08/Ol/2023 Contractors Poll. $1,000,000 Liability Deductible $25,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 4 } 75r a CERTIFICATE HOLDER CANCELLATION n SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE N t POLICY PROVISIONS. g The City of Fort Collins AUTHORIZED REPRESENTATIVE a 281 N College Ave o Ft Collins CO 80524 USA o ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000094675 LOC#: A ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMEDINSURED Aon Risk Services Northeast, Inc. ATI Restoration, LLC & all subsidiaries POLICY NUMBER See Certificate Number: 570100098718 CARRIER NAIC CODE See Certificate Number: 570100098718 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Subsidiaries List Restoration Buyer Group Holdings L.P. (Delaware) New American Technologies, Inc. (California) ATI Holder, LLC (Delaware) ATI HoldCo, LLC (Delaware) ATI Intermediateco, LLC (Delaware) ATI Restoration, LLC (Delaware) Carolina Restoration Services of North Carolina, LLC (North Carolina) ]&M Keystone, Inc. (California) Mark 1 Restoration Service, LLC (Delaware) Procare Solutions, LLC (Tennessee) Quality First Builders, LLC (Florida) Lang Enterprises Ltd. Co. (Georgia) Omni Environmental LLC (New Hampshire) All County Remediation, LLC (Florida) Isosceles Holdings, LLC (Delaware) RT1 Restoration Services, LLC (Delaware) Cary Reconstruction Company, LLC (Delaware) ]FS Construction Group LLC (Delaware) Emergency Reconstruction, LLC (Delaware) Emergency Restoration Experts, LLC (Delaware) SOS Builders, LLC (Delaware) Venturi National Services, LLC (Delaware) Empire construction & Technologies, LLC (Delaware) Poole's Reconstruction and Restoration, LLC (Delaware) ACORD 101(2008/01) ©2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD +_� ® DATE(MM/DD/YYYY) A� CERTIFICATE OF LIABILITY INSURANCE I 07/31/2023 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 2D certificate does not confer rights to the certificate holder in lieu of such endorsement(s). ;= PRODUCER CONTACT Aon Risk Services Northeast, Inc. NAME: a New York NY Office (A/C.No.Ext):ONE 8662837122 (A No.): (800) 363-0105 one Liberty Plaza E-MAIL p 165 Broadway, Suite 3201 ADDRESS: _ New York NY 10006 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA: Zurich American Ins CO 16535 ATI Restoration, LLC & all subsidiaries INSURERB: Everest indemnity insurance Company 10851 3360 E La Palma Ave Anaheim CA 92806 USA INSURERC: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570101003088 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. Limits shown are as requested LTR TYPE OF INSURANCE INSD WVD I POLICY NUMBER MM/DD/YYY MM/DD/YYY LIMITS X COMMERCIAL GENERAL LIABILITY EFIMLOO149231 797UT=Z7717= EACH OCCURRENCE $1,000,000 CLAIMS-MADE ❑X OCCUR DAMAGE TO PREMISES(Ea occurrence) 000 rence $1,000, MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $2,000,000 0 X POLICY ❑JERT LOC PRODUCTS-COMP/OPAGG $2,000,000 0 OTHER: A AUTOMOBILE LIABILITY BAP-4446642-05 08/01/2023 08/01/2024 COMBINED SINGLE LIMIT $1,000,000 Ea accident X ANYAUTO BODILY INJURY(Per person) C Z OWNED SCHEDULED BODILY INJURY(Per accident) AUTOS ONLY AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE V ONLY AUTOS ONLY (Per accident) 1: N a X UMBRELLALIAB X OCCUR EFICUOO103231 08 O1 2023 08/01/2024 EACH OCCURRENCE $10,000,000 V EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 DED RETENTION A WORKERS COMPENSATION AND WC444664105 08 01 2023 08 01 2024 X PER STATUTE OTH- EMPLOYERS'LIABILITY Y/N ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? Y N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If as,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000—_ B Contractors Pollution EFIMLOO149231 08/01/2023 08/01/2024 Contractors Poll. $1,000,000 Liability Deductible Per Occ $25,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) rr� mot+ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ) EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. The City Of Fort Collins AUTHORIZED REPRESENTATIVE ` 281 N College Ave Ft Collins Co 80524 USA �} �o � 01988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000094675 LOC#: A ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMEDINSURED Aon Risk Services Northeast, Inc. ATI Restoration, LLC & all subsidiaries POLICY NUMBER See Certificate Number: 570101003088 CARRIER NAIC CODE see Certificate Number: 570101003088 EFFECTIVE DATE ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Subsidiaries List Restoration Buyer Group Holdings L.P. (Delaware) New American Technologies, Inc. (California) ATI Holder, LLC (Delaware) ATI Holdco, LLC (Delaware) ATI Intermediateco, LLC (Delaware) ATI Restoration, LLC (Delaware) Carolina Restoration Services of North Carolina, LLC (North Carolina) J&M Keystone, Inc. (California) Mark 1 Restoration Service, LLC (Delaware) Procare Solutions, LLC (Tennessee) Quality First Builders, LLC (Florida) Lang Enterprises Ltd. Co. (Georgia) Omni Environmental LLC (New Hampshire) All County Remediation, LLC (Florida) Isosceles Holdings, LLC (Delaware) RT1 Restoration Services, LLC (Delaware) Cary Reconstruction Company, LLC (Delaware) IFS Construction Group LLC (Delaware) Emergency Reconstruction, LLC (Delaware) Emergency Restoration EXperts, LLC (Delaware) SOS Builders, LLC (Delaware) Venturi National Services, LLC (Delaware) Empire construction & Technologies, LLC (Delaware) Poole's Reconstruction and Restoration, LLC (Delaware) GraEagle Construction & Development, LLC Jenkins Enterprises, LLC Roth operations, LLC ACORD 101(2008/01) ©2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC#: ACORD ADDITIONAL REMARKS SCHEDULE Page of `� AGENCY NAMED INSURED Moody Insurance Agency,Inc. Academy Roofing,Inc. POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance:Notes CONTRACTUAL LIABILITY APPLIES PER POLICY TERMS AND CONDITIONS Leased/Rented Policy Number:EPP0134068 Insurer:Cincinnati Insurance Companies NAIC Code:2000 Effective Dates:05/01/2023—05/01/2024 $150,000 Limit/$1,000 Deductible Installation Floater Policy Number:EPP0134068 Insurer:Cincinnati Insurance Companies NAIC Code:2000 Effective Dates:05/01/2023—05/01/2024 $500,000 Limit Contractors Pollution Policy Number:CSP305034 Insurer:Colony Insurance Company NAIC Code:39993 Effective Date:05/01/2023—05/01/2024 $1,000,000 Limit(Includes Mold Coverage) Policy Form CPLO01-0615 Includes: Blanket Additional Insured status when required by written contract. Coverage applies as Primary and Non-contributory when required by written contract. Blanket Waiver of Subrogation applies when required by written contract. General Liability: GA 233 0920 Form Attached Includes: Blanket Additional Insured status applies only to the extent provided in form GA 233 CO 0920 when required by written contract. Blanket Waiver of Subrogation applies only to the extent provided in form GA 233 0920 when required by written contract. Primary and Non-Contributory status only to the extent provided in form GA 233 CO 0511 when required by written contract. Designated Construction Project(s)General Aggregate Limit provided in form CG 25 03 05 09 Designated Location(s)General Aggregate Limit provided in form CIS 25 04 05 09 Auto Liability: AA 292 0620 Form Attached Includes: Blanket Additional Insured status applies only to the extent provided in form AA 292 0920 when required by written contract. Blanket Waiver of Subrogation applies only to the extent provided in form AA 292 0920 when required by written contract. Primary and Non-Contributory status only to the extent provided in form AA 292 0920 when required by written contract. Excess Liability: Excess Liability policy is on a follow form basis for the following underlying insurance coverages:General Liability,Automobile Liability,and Employers Liability.Umbrella follow form. Worker's Compensation: 359-B From Attached Includes Blanket Waiver of Subrogation.Status applies when required by written contract. IMPORTANT: The policy forms referenced will be sent via email only.To obtain copies,please send your request with the email address to certrequest@moodyins.com ACORD 101 (2008/01) @ 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD