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HomeMy WebLinkAbout463182 THE DAVEY TREE EXPERT COMPANY - INSURANCE CERTIFICATE (3)A I® CERTIFICATE OF LIABILITY INSURANCE DATE 0211812013 YYVY) 2013 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 CONTACT NAME: MARSH USA INC. PHO200 NC PUBLIC SQUARE, SUITE 1000 IAC. lf4, No): E-MAIL ADORESS: CLEVELAND, OH 44114-1824 Ann: cleveland.cenrequest@marsh.com INSURERS AFFORDING COVERAGE NAIC s I 08670-ALL-GAWU12-13 138731 RESICA HILL INSURER A: Old Republic Insurance Co 24147 INSURED THE DAVEY TREE EXPERT COMPANY INSURER B : NIA NIA INSURER o : NIA NIA 1500 N. MANTUA ST INSURER D : BrickSlreet Mutual Insurance Co. 12372 KENT, OH 44240 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: CLE 003912086 01 REVISION NUMBER: I 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 WPEOFINSURANCE AODL UBfl POLICY NUMBED MVLICY EFF OO/YYYY POLICY YV Y Milwic LIMITS A GENERAL LIABILITY MWZY 59631 0910112012 0910112013 EACH OCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE RENTED PREMISES Ea occurrence $ 2,000,ODO CLAIMS -MADE MOCCUR MED I (Any one Person) $ 5,000 PERSONAL tI ADV INJURY $ ZOOM GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG S 2,000,000 S JECT X POLICY PRO- LOC A AUTOMOBILE LIABILITY MWTB 21589 09101/2012 09/0112013 COMBINED SINGLE LIMIT E. ac.i ti 2,000,000 BODILY INJURY (Per person) _ $ X ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTO AUTOS S INON-OWNED PRO PccERTY DAMAGE Paraal a $ X X HIRED AUTOS AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S AGGREGATE $ EXCESS LIAB CLAIMS -MADE DIED RETENTION$ S A WORKERS COMPENSATION 111747100(ADS) 0910112012 09101/2013 X wOSTATU- OTH- A AND EMPLOYEES' LIABILITY ANY PHOPRIETOPJPARTNER/EXECUTIVE Y/ N OFFICER/MEMBER E%CLUDEDT � (Mandatory in NH) N/A MWXS 974 (CA, OH, NC, PA, WA) 0910112012 0910112013 E.L. EACH ACCIDENT $ SEE ATTACHED E.L. DISEASE - EA EMPLOYE $ SEE ATTACHED D If rs,descnbe under DESCRIPTION OF OPERATIONS below WCBt003360 (WV) Ob104/20t2 06104/2013 E.L. DISEASE - POLICY LIMIT $ SEE ATTACHED DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (Allach ACORD 101, Additional Remarks Schedub, it more apace is required) THE CITY, ITS OFFICERS, AGENTS, AND EMPLOYEES IS(ARE) INCLUDED AS ADDITIONAL INSUREDS) AS RESPECTS GENERAL LIABILITY AND AUTOMOBILE LIABILITY WHERE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT AND ONLY AS RESPECTS OPERATIONS PERFORMED ON THEIR BEHALF BY THE NAMED INSURED. Lei a:uoLnn�waa�na:I CITY OF FT. COLLINS ATTN: PURCHASING PO BOX 580 FORT COLLINS, CO 80524 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 dlw....... ii /jGrwtr ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 08670 LOC N: Cleveland ACORV 1i ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY MARSH USA INC. NAMED INSURED 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 Compersalion does not apply in MN. Coverage is obtained from Workers Canpensation Reinsurance Association (W.C.R.A.) as required by the stale. All above referenced Workers Compensation policies are Statutory. All Employers Liability limits are Each Accident. Disease -each employee; Disease -policy limit and are: 15MM, policy MWC 117471 00; $1 MM, policy MWXS 974 (excess 15MM SIR): 11 MM, policy WCB1003360. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights The ACORD name and logo are registered marks of ACORD