HomeMy WebLinkAbout507709 SERVPRO OF FORT COLLINS - INSURANCE CERTIFICATE,acoRc� CERTIFICATE OF LIABILITY INSURANCE
DATE (M%DD,YYYY)
03/07/2019
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
Doug Jones
c/o Artex Risk Solutions, Inc.
8840 E. Chaparral Rd.: Suite 275
Scottsdale, AZ 85250
INSURED
Avitus, Inc. dba: Avitus Group Alt. Emp: D&A Enterprises, Inc. dba: Servpro of Fort
Collins
175 N. 27th Street, Suite 800 PO Box 2506
Billings, MT 59103
(480)951-4177
SDL.BSD.Certil
A: American Zurich Insurance
L*I
COVERAGES CERTIFICATE NUMBER: 19MT901815020 REVISION NUMBER:
951-4266
NAIC R
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.
ILT TYPE OF INSURANCE
LTR
C
?iUBRI
POLICY NUMBER
MMIDDYYYY
MM/DD YYYY
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$
CLAIMS -MADE OCCUR
DAMAGE TO RENTED
PREMISES Ea occurrence
VIED EXP (Any one person)
$
PERSONAL & ADV INJURY
$ _
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$
PRODUCTS - COMP/OP AGG
_
$
POLICY jE O LOC
$
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$
BODILY INJURY (Per person)
$
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
- AUTOS ONLY AUTOS ONLY
BODILY INJURY (Per accident)
$
--
PROPERTY DAMAGE
Per accident
IS
$
UMBRELLA LIAR
I
I OCCUR
EACH OCCURRENCE
$
71CLAIMS-MADE
AGGREGATE
s
EXCESS LIAB
DED I I RETENTION $
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANYPROPRIETOR!PARTNEREXECUTIVE
OFFICERiMEMBEREXCLUDED? ❑
(Mandatory in NH)
NIA
WC 40-19-885-14
04/01/2019
04/01/2020
X SEATUTE ER
E.L. EACH ACCIDENT $ 1,000,000
— '--
E.L. DISEASE - FA EMPLOYEE $ 1,000,000
E.L. DISEASE - POLICY LIMIT $ 1,000,000
tl yes. describe under
DESCRIPTION OF OPERATIONS below
Location Coverage Period:
04/01/2019
04i01/2020 l Client# 905-CO
DESCRIPTION OF OPERATIONS - LOCATIONS; VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is required)
Coverage is provided for D&A Enterprises, Inc. dba: Servpro of Fort Collins
only those co -employees 308 N. Link Lane
of, but not subcontractors Fort Collins, CO 80524
to:
CERTIFICATE HOLDER t ANUtLLA I IUN
City of Fort Collins
215 N Mason St
Fot Collins, CO 80521
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
91988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and loco are reaistered marks of ACORD 2 of 2 11948