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HomeMy WebLinkAbout463182 THE DAVEY TREE EXPERT COMPANY - INSURANCE CERTIFICATE (4),4 �® CERTIFICATE OF LIABILITY INSURANCE DATE0812712013 YYY 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($), 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. PHONE FAX 200 PUBLIC SQUARE, SUITE 1000 -IAfO AICNo E-MAIL ADDRESS: CLEVELAND, OH 44114-1824 Alfn: cleveland.certrequest@marsh.com INSURERSAFFORDING COVERAGE NAICa 1 O 08670-ALL-GAWU-13-14 138731 RESICA HILL �/�pL INSURER A, Old Republic Insurance Co 24147 INSURED THE DAVEY TREE EXPERT COMPANY INSURER B NIA NIA INSURER C : N/A N/A 1500 N. MANTUA ST. INSURER D: BrickStreel Mutual Insurance Co. 12372 KENT, OH 44240 INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER: CLE-003912086-02 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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER MMILICY EFF ODIY " MMIDULICY IYY EXP YY LIMITS A GENERAL LIABILITY MWZY 300093 0910112013 09/0112014 EACH OCCURRENCE $ 2.000.000 X COMMERCIAL GENERAL LIABILITY DAMA E TO RENTED PREMISES (Ea occurrence) $ 2,000,000 CLAIMS -MADE Ifl OCCUR MED EXP (Any one person) $ 5,000 PERSONAL S ADV INJURY $ 2,000.000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP/OP AGG $ 2.000,000 $ X POLICY PRO-JECT El LOC A AUTOMOBILE LIABILITY MWTB 22038 09101013 0910112014 COMBINED SINGLE LIMIT Ee a.,cleni $ 2000000 BODILY INJURY(Per person) $ ANY AUTO BODILY INJURY(Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS Ix PROPERTY DAMAGE Par amdenl $ HIRED AUTOS X NON -OWNED AUTOS UMBRELLA DAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS UAB CLAIMSAIA.DE DED RETENTION$ $ A WORKERS COMPENSATION MAC 300092 00 (ADS) 09/01/2013 09101I2014 11 WC STATUS OTH- ER A AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICER/MEMBER EXCLUDED? � (Mandatory in NH) NIA MWXS 300094 (CA, OH, NC, PA, WA) 09101/2013 0910112014 E.L. EACH ACCIDENT g SEE ATTACHED E. L. DISEASE - EA EMPLOYE $ SEE ATTACHED D If yes describe under DESCRIPTION OF OPERA rIONS below WCB1003360 (WV) 0610412013 06104/2014 E. L. DISEASE -POLICY LIMIT $ SEE ATTACHED DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If mom space Is required) THE CITY, ITS OFFICERS, AGENTS, AND EMPLOYEES ]$(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. 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 13E DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Luann M. Glavac du It "P"' 0" /J�l ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 08670 LOC #: Clevel ACORO® 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 not apply in MN. Coverage is obtained from Workers Compensation Reinsurance Association (W.O.R.A.) as required by the slate. All above referenced Workers Compensation policies are Statutory. All Employers Liability limits are Each Accident; Disease - each employee; Disease - policy limit and are: $5MM, poricy NWC 300092 00; $1 MM, policy MWXS 3DD094 (excess S5MM SIR); $1 MIN, policy WCB1003360. 2008 ACORD CORPORATION_ All rinhle rwswrvwd The ACORD name and logo are registered marks of ACORD Acoiza CERTIFICATE OF LIABILITY INSURANCE `�. DD/YYV ) DA08/27/2013 27/20 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% AA&NAExtlAIc NeF E-MAIL ADDRESS: CLEVELAND, OH 44114-1824 All develand.cemequest@marsh.can INSURERS AFFORDING COVERAGE NAIC tl INSURER A ; Old Republic Insurance Co 24147 08670-ALL-GAWU-13-14 138731 RESICA INSURED THE DAVEY TREE EXPERT COMPANY 1500 N. MANTUA ST. INSURER B NIA WA INSURER C : NIA WA INSURER D: BrickStreet Mutual Insurance Co. 12372 KENT, OH 44240 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: CLE-003394930-21 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 INSURANCE ADDL SUBR POLICY NUMBER EFF MM/DDIYYYY MM/DDPOLICY Y EXP IYYYY LIMITS A GENERAL LIABILITY MWZY 300093 09/012013 09101014 EACH OCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY DAMA T RENTED PREMISES Ea ocwnence $ 2,000,000 CLAIMS -MADE M OCCUR MED EXP (Anyone Person) $ 5,000 PERSONAL 8 ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP/OP AGG $ 2,000,000 $ X I POLICY PRO- LOC A AUTOMOBILELIABILITY MWTB 22038 091012013 09101/2014 COMBINED SINGLE LIMIT Ea accident 2,000,000 BODILY INJURY (Per person) It X ANY AUTO BODILY INJURY (Per accidem) $ ALL OWNED SCHEDULED AUTOS AUTOS PROPERTY DAMAGE f Per accident $ X N NOWOMED MIRED AUTOSAUTOS S UMBRELLA LJAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS-01ADE DED RETENTION $ $ A WORKERS COMPENSATION MWC 300092 00 (ADS) 09/01/2013 0910112014 X I NICSTATu- I OTH- A AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE Y / N OFFICERIMEMSER EXCLUDED? N] (Nummflory in NH) NIA MWXS 300094 (CA, OR, NC, PA, WA) 09/01I2013 09N1I2014 E.L. EACH ACCIDENT $ SEE ATTACHED E L DISEASE - EA EMPLOYEd $ SEE ATTACHED D If yes aih dese under DESCRIPTION OF OPERATIONS oelr � WCB1003360 06104/2013 0610412014 E L DISEASE - POLICY LIMIT SEE ATTACHED $ DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If mom apace Ia required) CITY OF FORT COLLINS IS(ARE) INCLUDED AS ADDITIONAL INSURED(S) 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. 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. AUTHORRED REPRESENTATIVE of Mamh USA Inc. Luann M. Glavac a&-.-r".-- f►Z '40'� 01988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 08670 LOC #: Cleveland AGENCY MARSH USA INC. POLICY NUMBER CARRIER ADDITIONAL REMARKS SCHEDULE Page 2 of 2 NAIC CODE NAMED INSURED THE DAVEY TREE EXPERT COMPANY 1500 N. MANTUA ST. KENT, OH 44240 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 not apply in MN. Coverage is obtained from Workers Compensation 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: $5MM, policy MWC 300092 00; $1MM, policy MWXS 300094 (excess $5MM SIR); $1MM, policy WCB1003350. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACOROCERTIFICATE OF LIABILITY INSURANCE ��. DATE YYYY 2013 0827/2013® THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terns and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER MARSH USA INC. 200 PUBLIC SQUARE, SUITE 1000 CONTACT NAME: PHONE FAX Wr- (AfC No : E-MAIL ADDRESS: CLEVELAND, OH 441 M1824 Am: develand.CEfVeguest@nfar$h.conl INSURERS) AFFORDING COVERAGE NAIC 4 INSURERA: Old Republic Insurance Co 24147 08670-ALL-GAWU-13.14 138731 RESICA COLE INSURED THE DMA TREE EXPERT COMPANY 1500 N.. MANTUA ST. INSURER B: WA WA wsuRER c : NIA NIA INSURER D : BrickStrmt Mutual Insurance Co. 12372 KENT, OH 44240 INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: CLE-003804494-06 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 INSURANCE ADDL SUBR POLICY NUMBER MM LICY EFF IDD/YYVYI POLICY EXP (MMIDOMYYI LIMITS A GENERAL LIABILITY MWZY 300093 09/0112013 0910112014 EACH OCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES E...,ance $ 2,000,000 CLAIMS -MADE F T] OCCUR MED EXP (Any one person) $ 5,000 PERSONAL a ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2.000,000 $ X POLICY PRO- JECT LOC A AUTOMOBILE LIABILITY MWTB 22038 09101/2013 09101/2014 COMBINED SINGLE LIMIT Ea accident 2,000,000 BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS Ix Per acadenl $ X NONOWNEDPROPERTYDAMAGE HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION$ $ A WORKERS COMPENSATION MWC 300092 00 (ADS) 09/0112013 0910112014 X WCSIIQR TATU- OTM- A AND EMPLOYERS' LIABILITYRYIN ANY PROPRIETOR/PARTNER/EXECUTIVE Oandart (MEMBER EXCLUDE09 MN 1Miedafery In NH) NIA MWXS 300094 (CA, OH, NC, PA, WA) 09/01/2013 0910112014 E.L. EACH ACCIDENT SEE ATTACHED $ E L DISEASE - EA EMPLOYE $ SEE ATTACHED D If yes desce under DESCrihRIPTION OF OPERATIONS below WCB1003360 (WV) 06104/2013 0610412014 E.L. DISEASE - POLICY LIMIT SEE ATTACHED $ DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace 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. 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 prN.sis, tf►j .b� 9)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 #: Cleveland ACORE® 11i 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: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers Compensation does not apply in MN. Coverage is obtained from Workers Compensation Reinsurance Association IW.C.RA.) as required by the slate. All above referenced Workers Compensation policies are Statutory. All Employers Liability limits are Each Accident; Disease -each employee; Disease - policy limit and are: $5MM, policy MWC 300092 00: $1 MM, policy MWXS 300094 (excess $5MM SIR); $1 MM, policy WC01003360. ACORD 101 (2008/01) © 2008 ACORD CORPORATION- All rici reRnrvnd. The ACORD name and logo are registered marks of ACORD