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HomeMy WebLinkAboutWILLMARK ENTERPRISES INC - INSURANCE CERTIFICATE (2)AC40RH CERTIFICA' E OF LIABILITY INSURANCE DA06/29/2020� NiS 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(les) musthave 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 Moody Insurance Agency - - NAME: Moody Insurance Agency, Inc. PHONE (303) 824-6600 aC No): (303) 370-0118 8055East TuftsAvenue osdrequest@moodyins.00m - - - ADDRESS: _ Suite 1000 INSURERIS) AFFORDING COVERAGE _ _ NAIC4 Denver CO 86237 INSURERA: Selective _ _ 14376 INSURED INSURER B: Plnnacol Assurance 41190 Wllimark Enterprises Inc INSURER C : P O Box 120 INSURER D INSURER E : Firestone O 80520-0120 INSURER F COVERAGES CFRTIFICATF NIIMRFR• 20-21 Master GOl to=%Acinal U"Moeo. 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 MICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCEAFFCRDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALLTHE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, i TRR TYPE OF INSURANCE AUDLSUHH -0 POLICY NUMBER POLICY MMIO EFF . MMID POUCY. LIMITS A COMMERCIALGENERAL LIABILITY CLAIMS -MADE ® OCCUR Y S2323475Do 07/01/2020 07/01/2021 EACH OCCURRENCE E 1,000,000 PREMISES' Ea o=rronce $ Mum MED EXP(Any one Derson) $ 10,000 PERSONALBADVINJURY $ 5000;000 GEN'LAGGREGATE LIMITAPPLIES PER: POLICY ®jECTT LOC OTHER: GENERALAGGREGATE $ 2,000,000 PRODUCTS -COMPIOPAGG $ 2.000,000 $ A AUTOMOBILE LIABILITY '. ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY J AUTOS ONLY — S23234'7500 . 07/01/2020 07/01/2021 - I COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY(per Derson) E BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per actldent $ S A 21 UMBRELLA UAB EXCESSLULB x OCCUR CLAMS -MADE S232347500 07/01/2020 07/01/2021 EACH OCCURRENCE $ 1,000,000 I AGGREGATE $ 1,000,000 DED I X RETENTION $. 10,000 $ B WORKERS COMPENSATION AND EMPLOYERS': LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE ❑ OFFICERIMEMBER EXCLUE Ifr .abrylnNH)md If vas. eearre» unae. DESCRIPTION OF OPERATIONS below _ NIA 4059734 - - 07/01/2020 07l01/2021 PER OTPH STA7UT ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,D00 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Addlttoilal Remarks Schedule, may be attached IT more spade Is required) City of Fort Collins 300 LaPorte Ave Fort Collins 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. ©1988-20, ACORD 25 (2016103) The ACORDi name and logo are registered marks of ACORD All rights reserved. A O d AGENCY CUSTOMER ID: 00003185 LOC REMARKS SCHEDULE Page - of AGENCY Moody Insurance Agency, Inc. NAMED INSURED Willmark Enterprises Inc POLICY NUMBER CARRIER NAIC CODE EFFECTm/E DATE: AUUI I IUNAL KtMAKK, r THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance: Notes CONTRACTUAL LIABILITYAPPLIES PER POLICY TERMS AND CONDITIONS Liability: 0119 Form Attached Includes: Additional Insured status applies only to the extent provided in form CG 7300 0119 when required by written contract. Waiver of Su6rogation applies only to the extent provided in form CG 7300 0119 when required by written contract. and Non -Contributory status only to the extent provided in forin CG 7300 0119 when required by written contract. CA 7809 1117 Forth Attached Includes: Blanket Additional Insured status applies only to the extent provided in form CA 7809 1117 when required by written contract. Blanket Waiver of Subrogation applies only to the extent provided in four CA 7609 1117 when required by written contract. Primary and Non -Contributory status only to theextent provided in form CA 7809 1117 when required by written contract. Umbrella Liability: Umbrella Liability policy is on a follow form basis for the following Worker's Compensation: 359-B From Attached Includes Blanket Waiver of Subrogation. forms referenced will be sent via email only. To obtain insurance coverages: General Liability and Automobile Liability. when required by written contract. please send your request with the email address to oertrequest@moodyins.com The ACORD and logo are registered marks of ACORD