Loading...
HomeMy WebLinkAbout463182 THE DAVEY TREE EXPERT COMPANY - INSURANCE CERTIFICATE (8)A�� DATE (MM/DD/YYYY) C" CERTIFICATE OF LIABILITY INSURANCE 08/17/2018 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 CONTACT MARSH USA INC. NAME: PHONE FAX 200 PUBLIC SQUARE, SUITE 3760 A/C No (A/C. No): CLEVELAND, OH 44114-1824 E-MAIL Attn: Cleveland.CertRequest@rnarsh.com _ADDRESS: INSURER S AFFORDING COVERAGE NAIC # 104250 RESOU RICHA INSURER A: Old Republic Insurance Com an 124147 INSURED The Davey Tree Expert Company Davey Resource Group, Inc. 1500 N. Mantua Street Kent, OH 44240 INSURER B : E: rnVFAAPFC CERTIFICATE NI IMRFR• CI F-nn5R9R632-nR RFVISION NIIMRFR- 4 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 I LTR OF INSURANCE ADDLSUBRTYPE INSD WVD POLICY NUMBER MM DD YYYY MM DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY 314042 09/01/2018 09/01/2019 EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE � OCCUR DA AGE ToTED PREM SESOEa oNc......ce $ 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 PRODUCTS - COMP/OP AGG $ 2,000,000 X PRO- POLICY JECT LOC $ OTHER A AUTOMOBILE LIABILITY MWTB 314041 09/01/2018 09/01/2019 COMBINED SINGLE LIMIT Ea accident $ 2,000,000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAB DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? ❑N (Mandatory in NH) NIA MWC 31404000 (AOS) 09/01/2019 X PER oTH- STATUTE ER E.L. EACH ACCIDENT $ 5,000,000 E.L. DISEASE - EA EMPLOYEE $ 5,000,000 E.L. DISEASE - POLICY LIMIT $ 5,000,000 If yes describe under DESCRIPTION OF OPERATIONS below 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 / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) THE 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. r•c0T1r1r+AT11= unl ncn CANrtFI I ATIr)N CITY OF FORT COLLINS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 215 N MASON ST. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF FORT COLLINS, CO 80524 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Luann M. Glavac dgp 007 ti U 1Vt5tl-ZUIb AUUKL) k UKl'UKA I IUN. All rlgnLS reserve0. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN101565730 LOC #: Cleveland A� oRD® ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED MARSH USA INC. The Davey Tree Expert Company Davey Resource Group, Inc. 1500 N. Mantua Street POLICY NUMBER Kent, OH 44240 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 Workers Compensation reinsurance association (W.C.R.A.) as required by the state. Minnesota Employers Liability is covered by policy number MAC 31404000. The Excess Workers Compensation policy does not include The Care of Trees, Inc.; Wolf Tree, Inc.; S&S Tree & Horticultural Specialists, Wetland Studies and Solutions, Inc,, and Arborguard Tree Specialists. ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD