HomeMy WebLinkAbout463182 THE DAVEY TREE EXPERT COMPANY - INSURANCE CERTIFICATE (11)� 8 DATE(MM/DD/YYYY)
AC
CERTIFICATE OF LIABILITY INSURANCE 08/28019
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
NAME:
Marsh USA Inc. FAX
200 Public Square, Suite 3760 PHONE (A/C, No):
Cleveland, OH 44114-1824 E-MAIL
Attn: Cleveland.CertRequest@marsh.com ADDRESS:
INSURE S AFFORDING COVERAGE
104250 RESOU RICHA INSURER A: Old ublic Insurance Company24147
INSURED INSURER B :
The Davey Tree Expert Company - _ - --
Davey Resource Group, Inc. INSURER C :
1500 N. Mantua Street INSURER D :
Kent, OH 44240 - - ---
INSURER E :
INSURER F :
..... .....� r,rrr A rr ur 1AAoco. rI C_nnSPnaR"-1,I DFI/ICIrIrd M[IRARFR- 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
LTR
TYPE OF INSURANCE
ADOL
SUER
POLICY NUMBER
POLICY EFF
111111111001YYYY1MMIDDIYYVY
POLICY EXP
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
MWZY31404219
09/0112019
09/01/2020
EACH OCCURRENCE
-D-WI-AGE
$ 5,000,000
CLAIMS -MADE FTI OCCUR
TO RENTED
PREMISES Ea occurrence
$ 5,000.000
MED EXP (Any one person)
$ 25,000
PERSONAL & ADV INJURY
$ 5,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 5,000,000
PRODUCTS-COMP/OP AGG
$ 5,000,000
POLICY El PRO- ❑ LOC
JECT
Pq
$
OTHER
A
AUTOMOBILE LIABIItry
MWf831404119
09/01/2019
09/0112020
COMBINED SINGLE LIMIT
Ea accident)$
5,000,000
BODILY INJURY (Per person)
$
X ANY AUTO
BODILY INJURY (Per accident)
$
OWNED SCHEDULED
AUTOS ONLY AUTOS
X HIRED X NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPERTYDAMAGE
Per accident
$
_
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
EXCESS LIAB
CLAIMS -MADE
$
DED RETENTION$
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y I N
ANYPROPRIETOR/PARTNERIEXECUTIVE
OFFICER/MEMBEREXCLUDED' N
(Mandatory in NH)
NIA
MWC314D4019(ADS)
01/2020
X I PER OTH-
STATUTE ER
_
$ 5,000.000
$ 5,000,000
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E L DISEASE -POLICY LIMIT
5,000,000
$
If yes describe under
DESCRIPTION OF OPERATIONS below
A
EXCESS WORKERS COMPENSATION
MWXS 31404319 (CA, OH, PA, NC, WA)
09/01/2019
09/0112020
WORKERS COMPENSATION
STATUTORY
EXCESS OF $5,000,000 SIR
EMPLOYERS LIABILITY
1,000.000
DESCRIPTION OF OPERATIONS I LOCATIONS I 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.
CITY OF FORT COLLINS
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
215N 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.
Luaiin M. Glavac
V l`JDd-LVID HI.Vr[U l.V rtt'VrtM I Ivl\. r,u rryurn rcacrvc�.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD