HomeMy WebLinkAboutKEIBON INC DBA ROTO-ROOTER - INSURANCE CERTIFICATEtanenw: a4A4o nete$LJn DATE ACORD. CERTIFICATE OF LIABILITY INSURANCE 1081210/9
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THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVEiY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT ! NSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICA HOLDER.
IMPORTANT: H the certificate holder is an ADDITIONAL IN URED, the policy(ies) must be endorsed. N SUBROGATION IS WANED, 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 endomement(s). _
PRODUCER W. CT SusanneJakubowitz
Althans Insurance Agency, Inc. PH�gHE 440 247-6422 FAX
A c No,: 440 247-2394
a No EM
543 East Washington St E-MAIL ADDRESS: cicerts@althans.com
P.O.BOx 570 INSURER(S) AFFORDING COVERAGE rwC 0
Chagrin Falls, OH 44022 INSURER A:ChbasaurtlyInwasno,co 24082
INSURED .INSURER B &ft Casussy 24074
Ke bon, Inc. dba Roto-Rooter INSURER C : ItnaaN lawrn,u Co of the fat sl 37478
3005 W. 29th St #G2
INSURER D : Aa.aran Fee and csiutlly Co 24066
Greeley, CO 80631
INSURER E
INSURER F :
rn�reewn_ec 9 C0TlClf AT= ulwnCCi omnginm PAWRFR-
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSU
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN
BELOW HAVE. BEEN ISSUED TO THE INSURED- NAMED ABOVE FOR THE POLICY PERIOD
CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
NCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
ADDL
SUB
POLICY NUMBER
POLICY EFF
D
POLICCY l.7CP_
MMIDD
LIMITS
A
X
cOMMERCIALGENERAL LIABILITY
CLAIMS5X OCCUR
PD Ded:500
BK5576b2189
1/07/2019
11107/2020
E�AqC�HpoccuRREHcE
$1000000
PREMI &-
$300OOO
X
MED EXP (Any one arson
s15,000
PERSONAL B ADV INJURY
$1000000
GENL AGGREGATE LIMIT APPLIES PER:.
POLICY F JECT LOC
OTHER:
GENERAL AGGREGATE
$2000000
.PRODUCTS - COMP/OP AGG
s2,000,000
$
D
AUTOMOBILE LIABILITY
ANY AUTOBODILY
H RED AUTOSA11T05 AUTOS
X NON -OWNED
AUTOS
Ix
BAA57602189
1/61/2019
11/07/202
COMBINED SINcLE UMrr
110001000
INJURY(Per person)
SALLOWNEDSCHEDULED
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Peracciern
$
-.
$ ..
B
X
UMBRELLA UAB
EXCESS LWB
X
OCCUR
CLAIMSMADE
US057602189
!
1/07/2019
11/07/2020
EACHOCCURRENCE
$1 000 000
AGGREGATE
$1 OOO O00
DED I X RETENTION $10000
$
C
WORIMRS COMPENSATION
AND EMPLOYERS' LIABWTY
ANY PROPRIETORIPARTNEWEXECUTNE Y I N
IM OFFICEREMBER EXCLUDED? �
(Mandatory In NH)
H9 .describe under
.DESCRIPTION OF OPERATIONS -below .
MIA
45WECAE3AEW
1/0712019
11/07/2020
X ONArum OTH-
E.L EACH ACCIDENT
$500000
E.L. DISEASE - EA EMPLOYEE
$500 000
E.L.DISEASE-POLICY LIMIT
-$500000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional
Rema*s Schedule, may be attached 0 more apace is required)
The City of Ft 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
ACCORDANCEWITH THE POLICY PROVISIONS.
AUTHORQED REPRESENTATIVE
' It 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25.(2014101)_ _ _ 1 of 1 The ACORD name and logo are registered marks of ACORD