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HomeMy WebLinkAboutTHE WESTERVELT COMPANY - INSURANCE CERTIFICATEISSUED AS A AND DOES NC of Insurance VIM] THE CERTIFICA LISTED BELOW. This is to Certify that I The Westervelt Compan & as per Named Ins6red'Endorsement 1 PO Box 48999 Tuscaloosa AL 35404-8999 is, at the issue date of this certificate, insured by the Company under Conditions and is not altered by eiiyrequirement, term or condition t e NAME AND j �be� Mine ADDRESS j�j OF INSURED INSURANCE listed below. The insurance.afforded by the listed policy(ies) is subject to all their terms, exclusions and or other document with rest ect to which this certificate may he i..i M TYPE OF POLICY EXP DATE ❑ EXTENDED EXTENDED — — POLICY NUMBER -' LIMIT OF LIABILITY POLICY TERM WORKERS COMPENSATION 61/30/2021 WA7-65D-434151-230 I COVERAGE.AFFORDED UNDER WC LAW OF THE FOLLOWING STATES: -230: All States Except: OH, WA, ND, WY EMPLOYERS LIABILITY _ Bodily Injuni b Accident ?d0 000Eaeh Acei ent 1NA7-65D-434151-250 I -250: CA Employers Liability: $1,000,000 Bodily Injury By Disease 500 000 Bodily Injury By Disease 500 000 Each Nrsog COMMERCIAL GENERAL LIABILITY 6/30/2021 TB2-651-434151-020 General Aggregate $2,000,000 m OCCURRENCE Products / Completed Operations Aggregate ❑ CLAIMS MADE - $2 000 000 Each Occurrence $1,000,000 RETRO DATE I Personal & Advertising Injury $1,000,000 Per Person/Organization I Other Dama a to remises rented to r Medical Expense: Sr AUTOMOBILE LIABILITY 6/30/2021 AS2-651-434151-030 "Ennn ach Accident-Siiii1c Limit $2 000 000 B.I. And P.D. Combined Each Person OWNED mNON -OWNED Each Accident or Occurrence .. _. ...- . HIRED IEach Accident or Occurrence OTHER ADDITIONAL COMMENTS -" -" - - -- The City of Fort Collins is included as additionally insured with respect to General Liability and Auto Liability as required by written contract I • If the certificate expiration date is continuous NOTICE BEFORE r i of Fort Collins ` PC3 BOX 580 Fort Collins CO 8( term, you will be notified if coverage is terminated or reduced. before the certificate expiration date. UNLESS A NUMBER OF DAYS IS ENTERED BELOW.) COMPANY WILL NOTCANCELOR REDUCE THE Liberty Mutual ACIES UNTIL AT LEAST 30 DAYS NOTICE InsurancrGroup Tammy Scipio Lawrenceville / 0505 AUTHORIZED REPRESENTATIVE 2530 Sever Road, Suite 200 J Lawrenceville GA 30043-4024 770-814-9002 7/1/2020 OFFICE PHONE DATE ISSUED This certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects.such insurance as is afforded by those Companies NM 772 07-10 56374875 1 Wi_836 1 6/20-6/21 - All 44nea I Donna 9mitala 1 7/1/2020 2:54:07 PM (CDT) I Page 1 of 2 LDI COI 268896 02 11 AGENCY CUSTOMER ID:LM_836 r� LOC #: ACC) V ADDITION REMARKS SCHEDULE lllkl�IPage of AGENCY NAMED INSURED Liberty Mutual Insurance Co. National Insurance.East I The Westervelt Company I &.as er Named Insured Endorsement 1 POLICY NUMBER PO BOX 48999 Tuscaloosa AL 35404-8999 CARRIER NAIC CODE _ EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: NM FORM TITLE: Certificate of Casualty Insurance (07/10) HOLDER: City of Fort Collins I ADDRESS: PO BOX 580 Fort Collins CO 80522 If changes are necessary, please contact: Tammy Scipio Phone: (470)539-5898 Email: Tammy.Scipio®LibertyMutual.com ACORD101 (2008101) The 56374875 1 LM-836 1 6/20-6/21 - A11 Lines I Donna © 2008 ACORD CORPORATION. All rights reserved. name and logo are registered marks of ACORD ATTACHMENT 7/1/2020 2:54:07 PM (CDT) I Page 2 of 2