HomeMy WebLinkAbout235414 JUDGE NETTING INC - INSURANCE CERTIFICATE (5)ACORN® CERTIFICATE OF LIABILITY INSURANCE
FDATE(MM/DDNYYY)
12/27/2018
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
Robert Harris Insurance Agency, Inc.
Lic. #0216736
3150 Bristol St., Suite 200
Costa Mesa CA 92626
CONTACT
NAME: Adriana Lopez
a/c NN Ext: (714)619-4480 A/C, NO; (714)619-4481
E-MAIL adriana@reharris.com
ADDRESS:
INSURERS AFFORDING COVERAGE
NAIC #
INSURERA:The Ohio Casualty Insurance Company
24074
INSURED
Judge Netting, Inc.
427 E. 17th St.
Costa Mesa, CA 92627
INSURER B: American Fire & Casualty Company
24066
INSURER C: Berkshire Hathaway Homestate Ins Co.
20044
INSURERD:Continental Divine Insurance
35939
INSURER E:
INSURER F :
COVERAGES CERTIFICATE NUMBER:19-20 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.
INSR
LTR
TYPE OF INSURANCE
ADDL
SUBR
POLICY NUMBER
POLICY EFF
MM(DD/YYYY
POLICY EXP
MMIDD/YYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
A
CLAIMS -MADE ❑X OCCUR
DAMAGE TO RENTED
PREMISES Ea occurrence
$ 100,000
MED EXP (Any one person)
S 15,000
BKO58275737
1/1/2019
1/1/2020
PERSONAL & ADV INJURY
$ 1,000,000
GENIAGGREGATE LIMITAPPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
POLICY PEA LOC
PRODUCTS-COMP/OPAGG
$ 2,000,000
Employee Benefits
$ 1,000,000
OTHER.
AUTOMOBILE
LIABILITY
COEaMBINED accidentSINGLE LIMIT
$ 1,000,000
X
BODILY INJURY (Per person)
$
B
ANYAUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
BAA58275737
1/1/2019
1/1/2020
BODILY INJURY (Per accident)
$
X
PROPERTY DAMAGE
Per accident
S
NON -OWNED
HIRED AUTOS Ix AUTOS
Medical Expense
S 5,000
UMBRELLA LIAR
X
OCCUR
EACH OCCURRENCE
$ 5,000,000
X
AGGREGATE
$ 5,000,000
B
EXCESS LIAB
CLAIMS -MADE
DED RETENTION $
$
ESABB275737
1/1/2019
1/1/2020
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y/ N
JUWC011411
1/1/2019
1/1/2020
X PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
$ 1,000,000
D
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? ❑
(Mandatory in NH)
N / A
JUWC011513
1/1/2019
1/1/2020
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE- POLICY LIMIT
$ 1,000,000
A
Contractors Equipment
5KO58275737
1/1/2019
1/1/2020
Leased/Rented Equipment $800,000
Deductible $1 , 000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
The City, its officers, agents and employees are named as Additional Insureds as their interest(s) may
appear regarding any and all work performed by the above named insured per attached CG8810 04/13 , CG
2037 0704 and CA8810 01/13.
CERTIFICATE HOLDER CANCELLATION
City of Fort Collins
PO Box 580
Fort Collins, CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Atkinson/ALOPEZ
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ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
INS026 (201401)