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Home My WebLink About133159 PAUL DAVIS RESTORATION - INSURANCE CERTIFICATE (2)AlCC)R�® V CERTIFICATE OF LIABILITY INSURANCE GATE25/2 /YYV1') D4/25/2D11 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 1-303-534-4567 IMA of Colorado, Inc. CONTACT NAME: PHONE FAX lAdC,No ExtA/C No: E-MAIL ADDRESS: 1550 17th Street Suite 600 Denver, CO 80202 INSURERS AFFORDING COVERAGE NAIC# INSURERA: PINNACOL ASSUR 41190 INSURED INSURER 8: OnePoint Employers Solutions, LLC and OnePoint HRO LLC INSURER C INSURER0: 5670 Greenwood Plaza Blvd., #200 INSURER E: Englewood, CO 80111 INSURER F: COVERAGES CERTIFICATE NUMBER: 20819063 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. INSft LTR 7ypE OF INSURANCE ADDLSUBR POLICY NUMBER MLICY M/DD/YYYY MM/OD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS -MADE F-IOCCUR MED EXP(Any one person) S PERSONAL& ADV INJURY S GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG S POLICY F_1 PRO n LOC IS OMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) BODILY INJURY (Per person) S ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS R BODILY INJURY (Per accident) S PROPERTY DAMAGE Per accdent $ NON -OWNED HIRED AUTOS AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTIONS S A WORKERS COMPENSATION AND EMPLOYERT LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? a N/A 40211674 05/01/11 05/01/12 TH- X WC TORY LIMIT ER E.L. EACH ACCIDENT S 100,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE S 100,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT I S 500,000 WC - If Yes Company owner(s) DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) This Certificate shows that Legacy Corporation DBA Paul Davis Restoration of Northern Colorado at 309 Lincoln Street, Fort Collins, CO 80524 is covered under the Workers Compensation Policy issued to OnePoint Employer Solutions LLC and OnePoint HRO LLC. ity of Fort Collins and Poudre Fire Authority Att: Ed Bonnette PO Box 580 Ft Collins . CO 80522 USA 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 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD SDZM 20819063