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HomeMy WebLinkAboutNOVOTNY ELECTRIC LLC - INSURANCE CERTIFICATENOVOT-1 OP ID: B3 ACORO" DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE F09/06/2018 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 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 endorsements . PRODUCER CONTACT House Account NAME:Brown & Brown Inc PHONE FAX 4532 Boardwalk Dr, Suite 200 A/c No EI�:970-482-7747 AC,No: 970-484-4165 Fort Collins, CO 80525 E-MAIL House Account ADDRESS: INSURERS AFFORDING COVERAGE NAIC p INSURER A:Pinnacol Assurance Company 41190 INSURED Novotny Electric LLC INSURER B: Westfield Insurance Company 24112 6874 N Franklin St. Loveland, CO 80538-1179 INSURERC: INSURER D : INSURER E : INSURER F : Rr1VFRArFC CFRTIFIrATF NI IMRFR• RFVISI(AN NIIMRFR- 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. INS R ADDL SUBR POLICY EFFtPOLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DDY/ MIDD/YYYY LIMITS B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00CLAIMS-MADE � OCCUR CWP7961490 10/23/20170/23/2018 PREMDAMAISES aoccuRENT PREMISES Ea occurrence) $ 500,00 MED EXP (Any one person) $ 6,00 PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY F1 PRO- JECT ❑ LOC PRODUCTS - COMP/OP AGG $ 2,000,00 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 _ _ BODILY INJURY (Per person) B X ANY AUTO CWP7961490 10/23/2017 10/23/2018 $ BODILY INJURY (Per accident) ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS $ $ PROPERTY DAMAGE Peraccdent $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,00 B EXCESS LIAB CLAIMS -MADE CWP7961490 10/23/2017 10/23/2018 DED I X RETENTION $ 0 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 4177813 10/01/2018 10/01/2019 X PER H STATUTE ER E.L. EACH ACCIDENT $ 500,00 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 500,00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 5U0 i)0 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) FAX: 970-224-6134 r`C0TICIr`ATC LIr11 r%co r`Aklr_FI I ATIf1A1 CITYFC2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins PO Box 580 Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE House Account © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD