HomeMy WebLinkAbout507709 SERVPRO OF FORT COLLINS - INSURANCE CERTIFICATE (2)�ca`RQ CERTIFICATE OF LIABILITY INSURANCE
`.... -
DATE(MM/DDiYYYY)
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
CONTACT
NAME:
PHONE FAX
N ; (480) 951-4177 _ (A/C No): (480) 951-4266
E-MAIL SDL.BSD.Certificates@artexrisk.com
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC #
Scottsdale, AZ 85250
INSURER A: American Zurich Insurance Company
40142
INSURED
Avitus, Inc. dba: Avitus Group Alt. Emp: D&A Enterprises, Inc. dba: Servpro of Fort
Collins
INSURER B :
INSURER C :
INSURER D :
175 N. 27th Street, Suite 800 PO Box 2506
Billings, MT 59103
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: 1 9MT901815020 REVISION NUMRER-
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
TYPEOF INSURANCE
A
INSID
I No
POLICY NUMBER
POLICY EFF
MM/DDiYYYY
POLICY EXP
MMiDDIYYYY
I
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$
CLAIMS -MADE a OCCUR
DAMAGE
PREMISES (Ea occurrence)
_
$
MED EXP (Any one person)
$
i
PERSONAL & AOV INJURY
$
GEN'L AGGREGATE LIMIT APPLIES PER:
— POLICY PRO-
JECT LOC
GENERAL AGGREGATE
$
PRODUCTS - COMPrOP AGG
$
$
OTHER:
AUTOMOBILE
LIABILITY
ANY AUTO
C BINEDSIN L LIMIT
Ea accident}
$
BODILY INJURY (Per person)
$
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Par accident)
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPERTYDAMAGE
Per accident
$
UMBRELLALIAB
I I OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
DIED RETENTION $
Is
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANYPROPRIETOR'PARTNEREXECUTIVE
OFFICERWEMBEREXCLUDED? ❑
N/A
i
WC 40-19-885-14
04/01/2019
04/01/2020
is gEATUTE OERH
E.L. EACH ACCIDENT $ 1,000,000
E.L. DISEASE - EA EMPLOYEE $ 1,000,000
(Mandatory in NH)
It yes describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT $ 1,000,000
Location Coverage Period:
04/01/2019
04/01/2020
Client# 905-CO
DESCRIPTION OF OPERATIONS LOCATIONS; VEHICLES (ACORD 101, Additional Remarks Schedule. may be attached if more space is required)
Coverage is provided tot 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 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
O 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and loco are recistered marks of ACORD 2of2 11929