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HomeMy WebLinkAbout463182 THE DAVEY TREE EXPERT COMPANY - INSURANCE CERTIFICATE (2)A� o® CERTIFICATE OF LIABILITY INSURANCE DATE12012 YYYV 08I29I2012 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 MARSH USA INC. 200 PUBLIC SQUARE, SUITE 1000 CONTACT NAMEPH fAIM. A/C No: E-MAIL ADDRESS: CLEVELAND, OH 44114-1824 Ann'. cleveland.certrequesl@marsh.com 1. Q 08670 ALL-GAWLI-12-13 138731 RESICA INSURERS AFFORDING COVERAGE NAIC M INSURER A: Old Republic Insurance Co 24147 INSURED THE DTREE EXPERT COMPANY 1500 N.. MA MANTUA ST INSURER B : NIA NIA INSURER C : NIA NIA INSURER D : BrickSDeet Mutual Insurance Co. 12372 KENT, OR 44240 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: CLE 003394930-17 REVISION NUMBER:3 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. INSR TR TYPE OF INSURANCE ADOL SUER POLICY NUMBER POLICY Y EXP MM/00/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 111 OCCUR MWZY 59631 09101/2012 0910112013 EACH OCCURRENCE $ 2,000,000 DAmAffffTO RENTED PREMISES Ea occurrence $ 2,000,000 MED EXP (My one person) $ 5,000 PERSONAL& ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE X POLICY LIMIT APPLIES PER: D PRO-LOC JECT PRODUCTS - COMP/OP AGO $ 2,000,000 $ A ANVATOBODILY 7'MOBISE LIABILITv ALLONEDSCHEDULED AUTOAUTOS NON -OWNED IRED AUTOS AUTOS MWTB 21589 09101/2012 0910112013 COMBINED SINGLE LIMIT Ea ¢..;dent _ 2 INJURY(Per person) $ BODILY INJURY(Peraccide0 $ PROPERTY DAMAGE Perac ;dent $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS MADE EACH $ -OCCURRENCE AGGREGATE S DED RETENTION$ $ A A D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE Y / N OFFICEWMEMBER EXCLUDED4 � (Mandatory in NH) If yes describe under DE SCRIPTION OF OPERATIONS below NIA MWC 117471 00 (AOS) MWXS 974 (CA, OR NC, PA, WA) WCB7003360 (WV) 09/0112012 0910112012 0610412012 0910112013 0910112013 06/0412013 X WC STATU- 2 E.L. EACH ACCIDENT $ SEE ATTACHED E.L. DISEASE - EA EMPLOYE $ SEE ATTACHED . EL. DISEASE -POLICY LIMIT $ SEE ATTACHED DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CITY OF FORT COLLINS IS(ARE) INCLUDED AS ADDITIONAL INSURED(S) AS RESPECTS GENERAL LIABILITY AND AUTOMOBILE LIABILITY WHERE REQUIRED BY WRITTEN CONTRACTOR AGREEMENT AND ONLY AS RESPECTS OPERATIONS PERFORMED ON THEIR BEHALF BY THE NAMED INSURED. L"Riltla Lg]\L9 CITY OF FORT COLLINS ATTN: PURCHASING PO BOX 580 FORT COLLINS, CO 80522 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 of Marsh USA Inc. Luann M. Glavac prN4.....- si %Lrl-rani © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 08670 LOC a: Cleveland -^1 ACORD ADDITIONAL REMARKS SCHEDULE Page 2 of AGENCY MARSH USA INC. NAMED INSURED THE DAVEY TREE EXPERT COMPANY 1500 N. MANTUA ST KENT, OR 44240 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 Workers Compensation does net apply in MN. Coverage is obtained from Workers Compensation Reinsurance Association (W.GR A.) as required by the state. All above referenced Waivers ers Compensation policies are Statutory. All Employers Liability limns are Each Accident; Disease- each employee; Disease- policy limit and are: S5MM, policy 1117471 00; $1 MM, policy MWXS 974 (excess $5MM SIR); $1 MM, policy WCB1003360. ACORD 101 (2008/07) m 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD A� " CERTIFICATE OF LIABILITY INSURANCE DATEYYYY) 01112912012 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 MARSH USA INC. 200 PUBLIC SQUARE, SUITE 1000 CONTACT NAME: PHONE FA% /uc. Bo ac No): E-MAIL ADDRESS: CLEVELAND, OR 44114-1824 Ann: cleveland.cenrequesl@marsh.com INSURERS AFFORDING COVERAGE NAIC • INSURER A: Old Republic Insurance Co 24147 OB670 -ALL GAWU 12-13 138731 RESICA COLE INSURED THE DAVEY TREE EXPERT COMPANY 1500 N. MANTUA SF INSURER B: NIA NIA INSURER C : NIA NIA INSURER D: BrickStreet Mutual Insurance Co. 12372 KENT, OR 44240 INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: CITE -003804494.02 REVISION NUMBER:3 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. INSR LTR TYPE OF IN ADDL SUBR POLICY NUMBER POLICY EFF M VDD/YYVV POLICY EXP MMI D/YYYY LIMITS A GENERAL LIABILITY MWZY 59631 09101/2012 09101/2013 EACH OCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 2,000,000 CLAIMS -MADE OCCUR MED EXP(Any one person) $ 5,000 PERSONAL d ADV INJURY $ 2,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG S 2,000,000 $ T POLICY F7 PRO LOG A AUTOMOBILE LIABILITY MWTB 21589 09/0112012 0910112013 COMBINED SINGLE LIMIT _LA accidept]_- _ 2,000A00 BODILY INJURY (Per person) $ X ANY AUTO id BODILY INJURY (Par eccenQ $ ALL OWNED SCHEDULED AUTOS AUTOS %IHIRED PROPERTY DAMAGE Peraccidera $ X NON -OWNED AUTOS AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION$ $ A WORKERS COMPENSATION MWC 11747100(AIDS) 09/01/2012 09101/2013 X I WOSTATIJ I OTH- A AND EMPLOYERS' LIABILITYER ANY PROPRIETOR/PARTNERIEXECUTIVE YO OFFICERIMEMBER EXCWDED? N (Mandatory in NH) N/A MWX$ 974 (CA, OH, NC, PA, WA) 0910112012 0910112013 E.L. EACH ACCIDENT $ SEE ATTACHED E.L. DISEASE - EA EMPLOYE $ SEE -ATTACHED D Il yes. describe under DESCRIPTION OF OPERATIONS below WCB1003360 (WV) 06/0412012 06104/2013 E.L. DISEASE -POLICY LIMIT SEE ATTACHED $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CITY OF FORT COLLINS IS(ARE) INCLUDED AS ADDITIONAL INSURED(S) AS RESPECTS GENERAL LIABILITY AND AUTOMOBILE LIABILITY WHERE REQUIRED BY WRITTEN CONTRACTOR AGREEMENT AND ONLY AS RESPECTS OPERATIONS PERFORMED ON THEIR BEHALF BY THE NAMED INSURED. W" 4Gut aVIl\ r 4, i L1 al V4$ 9G1C 1•14sIT\LL•1C CITY OF FORT COLLINS ATTN: PURCHASING P.O. BOX 580 FORT COLLINS, CO 80522 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 of Marsh USA Inc. Luann M. Glavac do, - 07 1401� 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 08670 LOC 1t: Cleveland ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY MARSH USA INC. NAMEDINSURED THE DAVEY TREE EXPERT COMPANY 1500 N. MANTUA ST KENT, OH 44240 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers Compensation does net apply in MN. Coverage is obtained from Workers Compensation Reinsurance Association (W.C.R.A) as required by the slate. All above referenced Workers Compensation policies are Statutory. All Employers Liability omits are Each Accident, Disease -each employee: Disease -policy limit and are: $5MM, policy MAC 117471 00; 11MM, policy MW%S 974 (excess 15MM SIR): $1 MM, policy WCB1003360. ACORD 101 (2008/01) m 2008 ACORD CORPORATION. All The ACORD name and logo are registered marks of ACORD