HomeMy WebLinkAbout133159 PAUL DAVIS RESTORATION OF NORTHERN CO-LEGAC - INSURANCE CERTIFICATEPAULD-1 OP ID: DA
,d►coRO CERTIFICATE OF LIABILITY INSURANCE
DAT06/18 D/YYYV)
06/18/13
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
4532 Boardwalk Dr, Suite 200 Fax: 970.484-4165
Fort Collins, CO 80525
Tyler B. Allen
ac° No Ea : ac No):
E-MAIL
ADDRESS:
INSURERS AFFORDING COVERAGE
NAIC E
INSURERA:SCCUra Insurance A Mutual Co.
22543
INSUREDPaul Davis Restoration of
INSURERS:Pinnacol Assurance Company
41190
Northern Colorado -Legacy Corp
309 Lincoln Ct
INSURER C: American Safety Indemnity Co.
25433
INSURER D:
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
LTR
I OF INSURANCE
ADDLTYPE
INSR
POLICY NUMBER
MMDO/YPOLICY E
YYY
MMLlICI YY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
E 1,000,00
C
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE O OCCUR
X
ENV030542-12-02
12I05/12
12/05/13
PREMISES Ea occurrence
E 60,00
MED EXP (Any one person)
E 5,00
PERSONAL s ADV INJURY
E 1,000,00
X Cntr Poll Liab
ENV030542-12-02
12/05/12
12/05/13
X
Mold
GENERAL AGGREGATE
E 3,000,00
ENV030542.12-02
12/05112
12/05113
GENL AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
E 3,000,00
RO LOC
POLICY X PFrT
lEmp Ben.
E 1,000,00
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accident
E 1,000,00
X
BODILY INJURY (Per person)
E
A
ANY AUTO
20A003186136-2000
12105112
12106/13
ALL OWNED SCHEDULED
AUTOS
BODILY INJURY (Per accidten)
ISAUTOS
NON -OWNED
HIRED AUTOS AUTOS
PROPERTY DAMAGE
Peraccident
E
E
X
UMBRELLA LIAB
X
OCCUR
EACH OCCURRENCE.
S 2,000,00
AGGREGATE
E 2,000,00
C
EXCESS UAB
CLAIMSWADE
ENU030543-12-02
12/05112
12 OS113
DED I X I RETENTIONS 10,000
E
---WORKERS
B
COMPENSATION -
AND EMPLOYERS' UABIUTY Y / N
ANY PROPRIETORFARTNERIEXECUTIVE ❑
OFFICERIMEMSER EXCLUDEOT
(Mandatory In NH)
under.L.
If DESCRIPTION OF OPERATIONS below
NIA
- __— _ __ _
156670
07/01/13
07101/14
X I WCSTATU-_ OTH-_
MER
E.L. EACH ACCIDENT
a 500,00
DISEASE - FJ. EMPLOYEES
Ebe
600,00
E.L. DISEASE - POLICY LIMIT
E 600.00
A
Per Prop Others"
20CP003186135.1000
12/05/12
12/05113
PPO" 300,00
A
Leased/Rented Eq
20CP003186135.1000
12/05/12
12105/13
Lsd/RnW 100,00
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Aeach ACORD 101, Addhbnal Rerruls Schedule, If more space Is rpulred)
The City of Fort Collins 6 the Poudre Fire Authority are named additional
insured
City of Fort Collins
Purchasing Division
Attn: David Carney
PO Box 580
CITYDIV
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
ACORD 25 (2010/05)
V 1SS8-ZU1U AGORU CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD