HomeMy WebLinkAbout463182 THE DAVEY TREE EXPERT COMPANY - INSURANCE CERTIFICATE (6)DATE (MM/DD/YYYY)
A4C R" CERTIFICATE OF LIABILITY INSURANCE
08117I2018
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 CONTACT
MARSH USA INC. NAME_
200 PUBLIC SQUARE, SUITE 3760 PHONE
NQ,EXt): lac, Not:
CLEVELAND, OH 44114-1824 E-MAIL
Attn: Cleveland.CertRequest@marsh.com ADDRESS:
INSURERS AFFORDING COVERAGE NAIC #
138731 RESICA _ INSURER A: Old Republic Insurance Company 24147
INSURED INSURER B :
The Davey Tree Expert Company
1500 N. Mantua Street INSURER C :
Kent, OH 44240
INSURER E :
COVFRAGFS CFRTIFICATF NI IMRFR• CI F-OMA90693-17 RFVISIr1N NI IMRFR• 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
ADDL
SUBR
POLICY NUMBER
POLICY EFF
MM/DDIYYYY
POLICY EXP
MM/DD/YYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
MWZY 314042
09/01/2018
09/01/2019
EACH OCCURRENCE
$ 2,000,000
CLAIMS -MADE I "' OCCUR
'AMA E To RENTED
PREMISES Ea occurrence
$ 2,000,000
MED EXP (Any one person)
$ 5,000
PERSONAL & ADV INJURY
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
X POLICY ❑PRO ❑ LOC
JECT
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
OTHER:
I
A
AUTOMOBILE
LIABILITY
^mNTB 314041
09/01,12018
09/0112019
CEonaB deDtSINGLE LIMIT
$ 2,000,000
X
BODILY INJURY (Per person)
$
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident)
$
X
HIRED X NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPERTY DAMAGE
Per accident
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
DED I I RETENTION $
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANYPROPRIETOR/PARTNER/EXECUTIVE Y / N
OFFICER/MEMBER EXCLUDED? ❑N
(Mandatory in NH)
NIA
MWC 31404000 (AOS)
O9/01/2019
X PER I OTH-
STATUTE ER
E.L. EACH ACCIDENT
$ 5,000,000
E.L. DISEASE - EA EMPLOYEE
$ 5,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 5,000,000
A
EXCESS WORKERS COMPENSATION
MWXS 314043 (CA,OH,PA,NC,WA)
09/01/2018
09/01/2019
WORKERS COMPENSATION
STATUTORY
EXCESS OF $5,000,000 SIR
EMPLOYERS LIABILITY
$1.000 000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
CITY OF FORT COLLINS 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.
GtK I IFIGA I t HULUtK GANUtLLA 1 ION
CITY OF FORT COLLINS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
ATTN: PURCHASING THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
PO BOX 580 ACCORDANCE WITH THE POLICY PROVISIONS.
FORT COLLINS, CO 80522
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Luann M. Glavac dkrr..�.r. A-jsv
@ 1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD