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HomeMy WebLinkAboutBelfor USA Group, Inc. - Insurance Certificate 2023-2025 ® CERTIFICATE OF LIABILITY INSURANCE DAT06/6/20223 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 w certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT AOn Risk services Central, Inc. NAME: y MSC# 1738S (A/C.No.Ext): (866) 283-7122 (FAX No.): (800) 363-0105 AOn E-MAIL PO Box 1447 ADDRESS: _ Lincolnshire IL 60069 USA INSURER($)AFFORDING COVERAGE NAIC# INSURED INSURER A: Steadfast Insurance Company 26387 Belfor USA Group, Inc. INSURER B: ACE American Insurance Company 22667 dba Belfor Property Restoration 5085 Kalamath Street INSURERC: AIG specialty Insurance Company 26883 Denver CO 80221 USA INSURERD: ACE Property & casualty insurance Co. 20699 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570100036343 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 Lin 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 AUU INSR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MWDD/YYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY HDOG EACH OCCURRENCE $10,000,000 CLAIMS-MADE X�OCCUR PREMISES Ea occurIl rence $2,000,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $10,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $10,000,000 POLICY ❑X JE� �LOC PRODUCTS-COMP/OPAGG $10,000,000 c OTHER: o n B ISA H10715763 07/01/2023 07/01/2024 COMBINED SINGLE LIMIT `r' AUTOMOBILE LIABILITY $5,000,000 Ea accident) JX ANYAUTO BODILY INJURY(Per person) C Z OWNED SCHEDULED BODILYINJURY(Peraccident) a)AUTOS AUTOS HIREDAUOTOSY X NON-OWNED PROPERTY DAMAGE V ONLY AUTOS ONLY Per accident r d D X UMBRELLA LIAB X OCCUR XEUG;75 05 07 0112023 07 Ol 2024 EACH OCCURRENCE $5,000,000 V EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED RETENTION B WORKERS COMPENSATION AND WLRC07 Ol 2 3 07 Ol 2024 X PER STATUTE OTH. EMPLOYERS'LIABILITY ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N A05 Stop Gdp B OFFICER/MEMBEREXCLUDED? N/A SCFCS070063A 07/01/2023 07/01/2024 E.L.EACH ACCIDENT $1,000,000 (Mandatory in NH) WI E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000-- DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) ' Y-" CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE g EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE $ POLICY PROVISIONS. S City Of Fort Collins AUTHORIZED REPRESENTATIVE 281 N. College Ave. o Fort Collins CO 80524 USA J o 0 01988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000005415 LOC#: A ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMEDINSURED Aon Risk Services Central , Inc. Belfor USA Group, Inc. POLICY NUMBER see certificate Number: 570100036343 CARRIER NAIC CODE see Certificate Number: 570100036343 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC# INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information,refer to the corresponding policy on the ACORD certificate form for policy limits. POLICY POLICY INSR ADDL SU13R POLICY NUMBER LIMITS LTR TYPE OF INSURANCE INSD WVD EFFECTIVE EXPIRATION DATE DATE (MM/DD/YYYY) (MM/DD/YYYY) WORKERS COMPENSATION S(C Gap 1,000,000 ACORD 101(2008/01) ©2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD DATE(MWDD/YYYY) AFRO CERTIFICATE OF LIABILITY INSURANCE I 06,26/2024 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 L SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this °f certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Aon Risk Services Central, Inc. PHONEV. MSC# 17385 (A/C.No.Ext): (866) 283-7122 aC.No.): (800) 363-0105 nBOX 1447 AD AIL PO DRESS: _ Lincolnshire IL 60069 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A; ACE American Insurance Company 22667 Belfor USA Group, Inc. INSURERB: ACE Property & Casualty Insurance Co. 20699 dba Belfor Property Restoration 5085 Kalamath Street INSURERC; AIG Specialty Insurance Company 26883 Denver CO 80221 USA INSURERD: steadfast insurance Company 26387 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570106852847 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/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY HDOG EACH OCCURRENCE $10,000,000 CLAIMS-MADE XX OCCUR DAMAPREMISESEa occurrence $2,000,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $10,000000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $10,000:000 CQ JECT POLICY PRO- �LOC PRODUCTS-COMP/OP AGO $10,000,000 20 OTHER: o h A ISA H10719409 07/01/2024 07 01 2025 COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY / / $5,OOO,OOO (Ea accident) 1xx ANYAUTO BODILY INJURY(Per person) 0 Z OWNED SCHEDULED BODILYINJURY(Peraccident) dAUTOSHIREDAUOT09Y X NON-OWNED PROPERTY DAMAGE U ONLY AUTOS ONLY Per accident :,,. it d B X UMBRELLALIAB X OCCUR XEUG7153974AO06 07 O1 2024 07 O1 2025 EACH OCCURRENCE $5,000,000 U EXCESS LIAR CLAIMS-MADE AGGREGATE $5,000,000 DED RETENTION A WORKERS COMPENSATION AND WLRC506 697 7 01 2024 07 01 25 X PER STATUTE OTH- EMPLOYERS'LIABILITY ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N AOS - OH - WA Stop Gap A OFFICER/MEMBEREXCLUDED7 N/A SCFC50698439 07/01/2024 07/01/2025 E.L.EACH ACCIDENT $1,000,000 (Mandatory in NH) WI E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000— DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) MIS 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 V� POLICY PROVISIONS. City Of Fort Collins AUTHORIZED REPRESENTATIVE 281 N. College Ave. Fort Collins CO 80524 USA 01988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000005415 LOC#: A ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMEDINSURED Aon Risk Services Central, Inc. Belfor USA Group, Inc. POLICY NUMBER see Certificate Number: 570106852847 CARRIER NAIC CODE See Certificate Number: 570106852847 --[ EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC# INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information,refer to the corresponding policy on the ACORD certificate form for policy limits. INSR ADDL SUBR POLICY NUMBER POLICY POLICY LIMITS LTR TYPE OF INSURANCE INSD WVD EFFECTIVE EXPIRATION DATE DATE (MM/DD/YYYY) (MM/DD/YYYY) WORKERS COMPENSATION rj Gap 1,000,000 ACORD 101(2008/01) ©2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD