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Home My WebLink About133159 PAUL DAVIS RESTORATION OF NORTHERN COLORADO - INSURANCE CERTIFICATE (2)PAULD-1 OP ID: I ,4�oRo CERTIFICATE OF LIABILITY INSURANCE 1 OAT12104D/YYYY) 2I04/13 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 15 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 endorsementtsl. PRODUCER Phone: 970-482-7747 Brown & Brown Inc Fax: 970-484-4165 4532 Boardwalk Dr, Suite 200 Fort Collins, CO 80525 Tyler B. Allen _ INSURED Paul Davis Restoration of 133 �5 (� Northern Colorado -Legacy Corp 7 309 Lincoln Ct Fort Collins, CO 80524 r`IV�— _ PHONE (Arc e : No E-MAIL ADDRESS: INSURERIS) AFFORDING COVERAGE NAIC 3 INSURER A: SeCUra Insurance A Mutual Co. 22543 INSURER B:PInnacol Assurance Company 41190 INSURER C:Crum & Forester Specialty Ins 44520 INSURER D: 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 TYPE OF INSURANCEAIR ADDL POLICY NUMBER MNVDDDDNLICY YYY MM/DDIYEYYP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 50,00 C X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X EPK102460 12/05/13 12/05/14 MED EXP (Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 X Mold EPK102460 12/05/13 12/05/14 X Cntr Pollution GENERAL AGGREGATE 3 3,000,00 EPK102460 12/05/13 12/06114 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ 3,000,00 Emp Ben. $ 1,000,00 POLICY X PRO LOC AUTOMOBILE UADUTY COMBINED B CI COMBNED OMSINGLE LIMB 1,000,00 BODILY INJURY (Per person) $ A X ANY AUTO 2OA003186136-3 12f0W13 12MS114 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Par accident) $ PROPERTY era olden DAMAGE 3 AUTOS D HIRED AUTOSP50.000 $ X PI - X UMBRELLA UAB X OCCUR EACH OCCURRENCE 3 2,000,0011 AGGREGATE $ 2,000,0011 C EXCESS LIAR CLAIMS -MADE EFX100925 12105/13 12/05h14 LIED I X I RETENTION$ 10,0 I3 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTNE YIN 156670 07/01/13 07/01/14 X WC STATU- OTH- E.L. EACH ACCIDENT $ 500,0 OFFICERIMEMBER EXCLUDEDI (Mandatory In NMI NIA E.L. DISEASE - EA EMPLOYEE 3 500,00 K yes, deaaibe under DESCRIPTION OF OPERATIONS Wm E.L. DISEASE -POLICY LIMIT $ 500, A Leased/Rented Eq 20CP0031861353 12/05/13 12/05/14 LBdlRntd 100,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attica ACORD 101, Additional Remarks Schedule, If more space Is required) The City of Fort Collins & the Poudre Fire Authority are named additional insured City of Fort Collins Purchasing Division Attn: David Carrey 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 (2010/06) Z 1999-2010 The ACORD name and logo are registered marks of ACORD All riahts reserved NOTEPAD P IN SURED'S NAME Paul Davis Restoration of OPP ID: D: DA PAGE 2 DATE 12/04/13 required by written contract the following apply: Additional Insured - Ongoing - CG2010 07/04 Additional Insured - Completed Operations CG2037 07/04 Waiver of Subrogation - CG2404 10/93 6 Non -Contributory Wording - CFENVOI036 Additional Insured - CFEN000011 Is Additional Insured - CAE0131 08/10 6 Non -Contributory Wording - CAE0131 08/10 Waiver of Subrogation - CAE0131 08/10