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HomeMy WebLinkAboutNOVOTNY ELECTRIC LLC - INSURANCE CERTIFICATE (2)NOVOT-1 OP ID: JV ACORO" DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 10/15/2018 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 endorsement(s). PRODUCER NAME: CONTACT House Account Brown & Brown Inc PHONE 970-482-7747 FAX 4532 Boardwalk Dr, Suite 200[A/C. A/C No El): -484-4165 970 Fort Collins, CO 80525 EMAIL House Account ADDRESS: INSURER A:Pinnacol Assurance Company 41190 INSURED Novotny Electric LLC INSURER B: Westfield Insurance Company__ 24112 6874 N Franklin St. wsuRERc: Loveland, CO 80538-1179 INSURER D : INSURER E : INSURER F : rnVEAAI^-EC CERTIFICATE MI IIUll RFVISInN NI IMRFP- 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 TYPE OF INSURANCE ADDL UBR� - POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE OCCUR CWP7961490 10/23/2018 10/23/2019 DA AGE TO RENTED PREMISES Ea occurrence) $ 500r00 ( MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY ❑PRO JECT D LOD 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 10/23/2018 10/23/2019 $ BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS PROPERTY DAMAGE Peraocd rA $ NON -OWNED HIRED AUTOS AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,00 B EXCESS LIAB l I CLAIMS -MADE CWP7961490 10/23/2018 10/23/2019 $ DIED I X I RETENTION $ 0 A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N 4177813 10/01/2018 10/01/2019 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 500,00 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / P` E.L. DISEASE - EA_EMPLOYEE $ 500,00 E.L. DISEASE - POLICY LIMIT If yes, describe under DESCRIPTION OF OPERATIONS below $ 500,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) FAX: 970-224-6134 P%C15TILI/-ATC Ur%1 r1CD rAKICEI I ATInKI 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 (2014/01) The ACORD name and logo are registered marks of ACORD