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HomeMy WebLinkAbout133159 PAUL DAVIS RESTORATION OF NORTHERN COLORADO - INSURANCE CERTIFICATEPAULD-1 OP ID: DA ,4caRo CERTIFICATE OF LIABILITY INSURANCE DAT12/05 DNYYY) lzlosnz 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 endorsements . PRODUCER Phone: 970-482-7747 CONTACT NAME Brown 8. Brown Inc Fax: 970�844165 4532 Boardwalk Dr, Suite 200 PHONE FA% ac NNE., o Eat : AIC No): E-MAIL ADDRESS: Fort Collins, CO 80525 Tyler B. Allen INSURERS AFFORDING COVERAGE NAIC N INSURER A: Secura Insurance A Mutual Co. 22543 1 ��) INSURED Paul Davis Restoration f INSURER a:Pinnacol Assurance Company 41190 Northern Colorado dba: Legacy Corporation dba: INSURER C:American Safety Indemnity Co. 25433 INSURER D: Dennis -Lain Corporation 309 Lincoln Ct Fort Collins, CO 80524 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. INSR TYPE OF INSURANCE ADBL�SUBR POLICY EFF POLICY E%P LTR POLICY NUMBER MMIDDNYYY MM/DDNYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,08 C X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1XI OCCUR X ENV030542-12-02 12/05/12 12/05113 AMAGEED PREM SESOE. ocRENourrrence $ 50,000 MED EXP (Any one person) $ 5,00 PERSONAL BADVINJURY $ 1,000,00 X CntrPoll Liab ENV030542-12-02 12/05/12 12/05113 X Mold GENERAL AGGREGATE $ 3,000,000 ENV030542-12-02 12105/12 12/05113 - GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG tS 3,000,000 POLICY X PRO LOC $ AUTOMOBILE LIABILITY D SINGLE LIMIT 1,000,00 $A NJURY(Per person) $ X ANY AUTO 20A003186136-2000 12/05/12 12105113 ALL OWNED SCHEDULED L(Eaa=identl NJURY (Per accident) $AUTOSAUTOSNON-OWNED HIREDAUTOS AUTOS TY DAMAGE$ tlent $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,00 AGGREGATE $ - 2,000,00 C EXCESS LIAB CLAIMS -MADE ENU030543-12 12/05112 12/05/13 DED I X RETENTION $ 10,000 $ 1 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE YIN OFFICERIMEMBER EXCLUDED? ❑ (Mandatory in NH) N / A 4156670 06/20112 07/01/13 X WC STATU- OTH- T RY LIMIT —ER E.L. EACH ACCIDENT $ 500,00 E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E. L. DISEASE -POLICY LIMIT $ 500,00 A Per Prop Others— 20CP003186135-1000 12105/12 12/05113 PPO** - 300,00 A Leased/Rented Eq 20CP003186135-1000 12/05/12 12105113 Lsd/Rntd 100,00 DESCRIPTION OF OPERATIONS / LOCATIONS f VEHICLES (Attach ACORD 101, AJElflonal Remades Schedule, If mom apace Is required) The City of Fort Collins S the Poudre Fire Authority are named additional insured CITYDIV City of Fort Collins Purchasing Division Attn: David Carrey PO Box 580 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 No Text