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HomeMy WebLinkAbout548809 DAVEY RESOURCE GROUP - INSURANCE CERTIFICATEA4C")?" CERTIFICATE OF LIABILITY INSURANCE DATE oana/2n015 YYY) (MMrD ots 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 FAX No): E-MAIL ADD CLEVELAND, OH 44114-1824 Attn: cleveland.certrequest@dmarsh.com INSURE S AFFORDING COVERAGE NAIC a INSURER A: Old Republic Insurance Co 24147 08670 -ALL-GAW-14-15 12DS30 RESOU NUTT INSURED DAVEY RESOURCE GROUP, A DIVISION OF INSURERS: THE DAVEY TREE EXPERT COMPANY INSURER C : INSURER D : 1500 N. MANTUA ST. KENT, OH 44240 INSURER E : INSURER F : CAVFRACFS CERTIFICATE NUMBER_ CLE-004240065-03 REVISION NUMBER:1 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 UBR POLICY NUMBER MN DIO�Y MPOLICY M UCDIYYYY LIMITS A GENERAL LIABILITY MWZY 302374 09/0112014 09/0112015 EACH OCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurr'noe $ 2,000,000 MED EXP (Any one Person) $ 5.000 CLAIAAS-MADE O OCCUR PERSONAL & ADV INJURY $ 2.000.000 GENERAL AGGREGATE $ 2,000,000 GETN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ INCL IN GEN AGG $ POLICY PRO LOC A AUTOMOBILE LIABILITY _ MWfB 302373 09/01/2014 09/01/2015 COMBINED SINGLE LIMIT Ea acadern 2,000,000 BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS X X NON -OW NED HIRED AUTOS AUTOS PROPERTY DAMAGE (Peracatlern $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED RETENTION$ $ A WORKERS COMPENSATION MWC 302372-00 (ADS) 09/01/2014 09/01/2015 WD STATuMIT- OTH- Top Yy AND EMPLOYERS' LIABILITY YIN(MN: ANY OFFICERIMEM ER/ EXCLUDED? (Mandatory in NH) N / A Employers Liability only, Work Comp provided by W.C. R.A.) E.L. EACH ACCIDENT 5,000,000 $ E.L. DISEASE - EA EMPLOYE $ 5,000,000 E.L. DISEASE - POLICY LIMIT 5,000,000 $ If yes, describe under DESCRIPTION OF OPERATIONS below A Excess Workers' Compensation MJVXS 302375 (CA, OH, NC, PA, WA) 09/01/2014 09/01/2015 Employers Liability Limit $1,000,000 Excess of $5,000,000 SIR DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, N more space is required) THE CITY, ITS OFFICERS, AGENTS AND EMPLOYEES 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 PO BOX 580 FORT COLLINS, CO 80522 ��1c��rissuLacl 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 00-7 © 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 ACORO® ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED MARSH USA INC. DAVEY RESOURCE GROUP, A DIVISION OF THE DAVEY TREE EXPERT COMPANY 1500 N. MANTUA ST. POLICY NUMBER KENT,OH 44240 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.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 limits are Each Accident, Disease - each employee, Disease - policy limit and are. $5MM - policy MWC 302372-0011 MM, policy MWXS 302375 (excess $5MM SIR). AGUKU 1U1 (ZUUSlU1) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD