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HomeMy WebLinkAbout463182 THE DAVEY TREE EXPERT COMPANY - INSURANCE CERTIFICATE (5)ACC>REP CERTIFICATE OF LIABILITY INSURANCE �/. UA812601)D YYYYI 08262014 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, SURE 1000 CONTACT NAME: PNONE ac No): E-MAIL ADDRESS: CLEVELAND. OH 44114-1824 ABn: develand.cervequest(@marsh.com INSURER B AFFORDING COVERAGE NAIC If INSURER A: Old Republic Insurance CD 24147 08670-ALL-GAWU-14-15 138731 RESICA COLE INSUREDTHE THE DAVEY TREE EXPERT COMPANY N. MANTUA ST. � l �, INSURER B WA WA INSURER C: WA WA INSURER D : KENT, OH 44240 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: CLE-0038044908 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 ADOL U POLICY NUMBER MN/ODPOUCY IYYYYI IMM/DDfYYY`YI LIMITS A GENERAL LIABILITY MWZY 3D2374 09101/2014 D9101/2015 EACH OCCURRENCE $ 2,00D,000 X COMMERCIAL GENERAL LIABILITY ­15RNTD PREMISES EaEoccunence $ 2,000,000 CLAIMS -MADE MOCCUR MED EXP(My one person $ 5,000 PERSONAL $ ADV INJURY If 2,000,000 GENERAL AGGREGATE $ 2,000,000 GEWL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO $ 2.000,000 X POLICY PRO- LOC IFCT $ A AUTOMOBILE LIABILITY MWTB 302373 0910112014 0910112015 COMBINED SINGLE LIMIT a accident 2,000,000 X BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Pere¢idem) $ X PROPERTY DAMAGE Peracddent $ NON -OWNED HIRED AUTOS N AUTOS 8 UMBRELLA LULB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIA6 CLAIMS -MADE DIED I I RETENTION $ A WORKERS COMPENSATION MWC 302372-00(ADS) 09/OV2014 0910112015 XoTH- VJCSTATu- IER A AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE Q OFFICER/MEMSER EXCLUDED'! (Mandatory in NH) NIA MWXS 302375 (CA, OH, NC, PA, WA) 09/01/2014 09101/2015 E.L. EACH ACCIDENT g SEE ATTACHED E.L. DISEASE -EA EMPLOYE $ SEE ATTACHED If yes, deacnioe `radar DESCRIPTION OF OPERATIONS below E. L. DISEASE -POLICY LIMIT SEE ATTACHED $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Ramon, Schedule. If mom space Is required) CITY OF FORT COLLINS IS(ARE) INCLUDED AS ADDITIONAL INSURED(S) AS RESPECTS GENERAL LIABILITY AND AUTOMOBILE LIABIUTY 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 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 Mamh USA Inc. Luann M. Glavac ar&.fw..... a7 /Io r ®1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 08670 LOC #: Cleveland Ac0 ® 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 Worers Compensation Reinsurance Association (W.C.R.A) as required by the state. Minnesota Employers Liability is covered by policy number MWC 302372-00. All above referenced Workers Compensation policies are Statutory. All Employers Liability limis are Each Accident; Disease - each employee; Disease -policy timil and are: E5MM, policy MWC 302372 -00; E1 MM, policy MWXS 302375 (excess S5MM SIR). ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD