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HomeMy WebLinkAboutBRIGHTVIEW LANDSCAPES LLC - INSURANCE CERTIFICATE (2).4C__ I , CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 09/17/2018 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 have ADDITIONAL INSURED provisions or 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 Aon Risk Services Northeast, Inc. New York NY Office CONTACT NAME: (AJCO.NNo. EXt): (866) 283-7122 (wc No ): (800) 363-0105 E-MAIL ADDRESS: One Liberty Plaza 165 Broadway, Suite 3201 New York NY 10006 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURERA: ACE American Insurance Company 22667 Brightview Landscapes. LLC 401 Plymouth Road Plymouth Meeting PA 19462 USA INSURER B: INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570073072180 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. Limits shown are as requested INSR LTR TYPE OF INSURANCE D INSD WVD POLICY NUMBER POLICY F MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY XSLG 1 EACH OCCURRENCE $1, 000, 000 CLAIMS -MADE X❑ OCCUR SIR applies per policy terns & condl Ions DAMAGE RENTED PREMISES Ea occurrence $1,000,000 X MED EXP (Any one person) $10, 000 Contractual Liability X XCU Hazard PERSONAL & ADV INJURY $1, 000, 000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $4,000,000 POLICY X❑ PRO - POLICY FX­] LOC PRODUCTS - COMP/OPAGG $4,000,000 OTHER: A AUTOMOBILE LIABILITY Y SCA H09090538 10/01/2018 10/01/2019 COMBINED SINGLE LIMIT Ea accident $3,000,000 BODILY INJURY ( Per person) X ANYAUTO OWNED SCHEDULED BODILY INJURY (Per accident) AUTOS ONLY AUTOS HIRED AUTOS NON -OWNED ONLY AUTOS ONLY PROPERTYDAMAGE Per accident UMBRELLA LAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS -MADE AGGREGATE DED RETENTION A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBEREXCLUDED? � N/A WLRC48583404 WC - A05 SCFC48583428 10/01/2018 10/01/2018 10/01/2019 10/01/2019 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $2 , 000 , 000 E.L. DISEASE -EA EMPLOYEE $2 , 000 , 000 (Mandatory in NH) If DESCRIPTION OF OPERATIONS below describe under We - WI E.L. DISEASE -POLICY LIMIT $2 , 000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Fort Collins is included as Additional insured in accordance with the policy provisions of the General Liability and Automobile Liability policies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. The City of Fort Collins AUTHORIZED REPRESENTATIVE Purchasing Department PO Box l l i cyan R. Fort Collins CO 80500 USA c/,j{'/ - c,/(�i _co N r` 0 0 0 r- 0 O Z N is U w r d C) ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS — COMPLETED OPERATIONS Named Insured Endorsement Number BrightView Landscapes, LLC Policy Symbol Policy Number Policy Period Effective Date of Endorsement XSL G71075771 001 10/01 /18 to 10/01 /19 10/01 /2018 Issued By (Name of Insurance Company) ACE American Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This Endorsement modifies insurance provided under the following: EXCESS COMMERCIAL GENERAL LIABILITY POLICY SCHEDULE Name Of Additional Insured Person(s) Or Organ izations : Location And Description Of Completed Opera - tions Any person or organization whom you have agreed to All locations where you perform work for such include as an additional insured under a written additional insured pursuant to any such written contract. contract, provided such contract was executed prior to the date of loss. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organiza- tion(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorse- ment performed for that additional insured and included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afford- ed to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance And Retained Limit: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Authorized Representative XS-21164a (04/13) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION Named Insured Endorsement Number BrightView Landscapes, LLC Policy Symbol Policy Number Policy Period Effective Date of Endorsement XSL G71075771 001 10/1/18 to 10/1/19 10/01/2018 Issued By (Name of Insurance Company) ACE American Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: EXCESS COMMERCIAL GENERAL LIABILITY POLICY SCHEDULE Name of Person or Organization: Any person or organization whom you have agreed to include as an additional insured under a written contract, provided such contract was executed prior to the date of loss. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance And Retained Limit: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Authorized Representative XS-6W25b (04/13) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 ADDITIONAL INSURED - DESIGNATED PERSONS OR ORGANIZATIONS Named Insured Endorsement Number BrightView Landscapes, LLC Policy Symbol Policy Number Policy Period Effective Date of Endorsement SCA H09090538 10/1/18 to 10/1/19 10/01/2018 Issued By (Name of Insurance Company) ACE American Insurance Company Incart tha nnliry ni—hor Tha romninrior of fha infnrmatinn is to ha r rnnlatari nnl,t whan Chic anrinrcomont lc icci sari ­hca iont to tha nronn—fin, of tha nnliry THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM AUTO DEALERS COVERAGE FORM MOTOR CARRIER COVERAGE FORM EXCESS BUSINESS AUTO COVERAGE FORM Additional Insured(s): Any person or organization whom you have agreed to include as an additional insured under a written contract, provided such contract was executed prior to the date of loss. A. For a covered "auto," Who Is Insured is amended to include as an "insured," the persons or organizations named in this endorsement. However, these persons or organizations are an "insured" only for "bodily injury" or "property damage" resulting from acts or omissions of: 1. You. 2. Any of your "employees" or agents. 3. Any person operating a covered "auto" with permission from you, any of your "employees" or agents. B. The persons or organizations named in this endorsement are not liable for payment of your premium. Authorized Representative DA-91U74c (03/16) Page 1 of 1 NAMED INSURED ENDORSEMENT Named Insured Endorsement Number BrightView Landscapes, LLC Policy Symbol Policy Number Policy Period Effective Date of Endorsement XSL G71075771 001 10/1/18 to 10/1/19 10/01/2018 Issued By (Name of Insurance Company) ACE American Insurance Company insert the poncy numoer. i ne remainaer or the inrormaaon is to oe compietea only wnen trns endorsement is issues suosequent to the preparation or the poncy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This Endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM EXCESS COMMERCIAL GENERAL LIABILITY POLICY It is agreed that the Named Insured is amended to read as follows: BrightView Landscapes, LLC BrightView Landscapes Services, Inc. BrightView Tree Care Services, Inc. BrightView Golf Course Maintenance, Inc. BrightView Enterprise Solutions, LLC BrightView Companies, LLC BrightView Chargers, Inc. BrightView Landscape Services, Inc. dba Marina Landscape Maintenance BrightView Tree Care Services, Inc dba Urban Tree Care (formerly known as Urban Tree Care) BrightView Landscape Services, Inc. dba Girard Environmental Services (formerly known as - Girard Environmental Services J&S Lawnman, Inc. BrightView Acquisitions Holdings, Inc. Authorized Agent LD-20286 (06/06) Page 1 of 1 SCHEDULE OF NAMED INSUREDS Named Insured Endorsement Number BrightView Landscapes, LLC Policy Symbol Policy Number Policy Period Effective Date of Endorsement SCA H09090538 10/01 /2018 to 10/01 /2019 10/01 /2018 Issued By (Name of Insurance Company) ACE American Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIERS COVERAGE FORM AUTO DEALERS COVERAGE FORM The Named Insured shown in the Declarations is amended to read as follows: BrightView Landscapes, LLC BrightView Landscape Services, Inc. BrightView Landscape Development, Inc. BrightView Tree Care Services, Inc. BrightView Golf Maintenance, Inc. BrightView Design Group BrightView Enterprise Solutions, LLC BrightView Companies, LLC BrightView Chargers, Inc. Western Landscape Construction William A. Guthridge and Son, Inc; BrightView Tree Care Services, Inc dba Urban Tree Care (formerly known as Urban Tree Care) BrightView Landscape Services, Inc dba Girard Environmental Services (formerly known as Girard Environmental Services) J&S Lawnman, Inc.; BrightView Acquisition Holding, Inc. Named Insured includes First Named Insured; other entities to be covered as of inception and any organization other than a partnership or joint venture, and over which you currently maintain ownership or majority interest, provided there is no other similar insurance available to that organization; and any other organization you newly acquire or form, other than a partnership or joint venture, and over which you maintain ownership or majority interest, provided: a) There is no other similar insurance available to that organization; and b) you notify us of such acquisition not later than 60 days after the end of the policy period. As respects newly acquired or formed organizations, coverage does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization. No person or organization is an insured with respect to the conduct of any current or past joint venture that is not shown as a Named Insured on this schedule. Authorized Representative DA-13118a (06/14) Page 1 of 1