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HomeMy WebLinkAbout106253 SERVICEMASTER OF FORT COLLINS - INSURANCE CERTIFICATE (3)HSINC-1 OP ID: DA ACORO� r ATE YY) (MM/DD/YY 015 CERTIFICATE OF LIABILITY INSURANCE 06/01/ D/YY 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 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 CONTANAME: CT Kdren E. Siwek, CPA Brown &Brown Inc PHONE 970-482-7747 F'C No): 970-484-4165 4532 Boardwalk Dr, Suite 200 ac No Ext: Fort Collins, CO 80525 Karen E. Siwek, CPA ADDRESS: ksiwek@bbcolorado.com INSURERS AFFORDING COVERAGE NAIC # INSURER A:Pinnacol Assurance Company 41190 INSURED HS Inc INSURER B: Crum & Forester Specialty Ins 44520 Servicemaster of FTC INSURER C: Westfield Insurance Company 24112 3054 Lake Canal Ct #120 Fort Collins, CO 80524 INSURERD: INSURER E: INSURER F : rnVFRAt:FS r:FRTIFICATF NI IMRFR• RFVISION NIIMRFR- 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 ADDLTYPE OF INSURANCE INSD SUBR POLICY NUMBER MM/DD/YPOLICY E LTR YYY MM/DD/Y Y LIMITS B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000. CLAIMS-MADErx] OCCUR REN OF EPK104328 06/01/2015 06/01/2016 DAMAGE ENTED REM SES ea occurrence) $ 50,00 MED EXP (Any one person) $ 5,00 X CPUProfessional PERSONAL & ADV INJURY $ 1,000,00 REN OF EPK104328 06/01/2015 06/01/2016 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY ❑PRO JECT LOC PRODUCTS - COMP/OP AGG $ 2,000,00 $ OTHER. AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,00 BODILY INJURY (Per person) C X ANY AUTO CWP6099227 06/01/2015 06/01/2016 $ BODILY INJURY (Per accident) ALL OWNED SCHEDULED AUTOS �_ AUTOS NON -OWNED HIRED AUTOS AUTOS X HPD X Ded $500 ired $ $ $ PROPERTY DAMAGE Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,00 AGGREGATE $ 2,000,00 B EXCESS LIAB CLAIMS -MADE REN OF EFX101499 06/01/2015 06/01/2016 DED I X I RETENTION $ 10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 4166362 06/01/2015 06/01/2016 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A E.L. DISEASE - EA EMPLOYEE $ 1,000,00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 C Equipment Floater 7 CWP6099227 06/01/1015 06/01/2016 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) f_FRTIFIrATF t-1r11 r1FR CONCFI I ATION CITYOFF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ft. Collins 215 N Mason St Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE, / ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD HSINC-1 PAGE 2 NOTEPAD INSURED'SNAME HS Inc OP ID: DA Date 06/01/2015 When required by written conract the following applies: Blanket Additional Insured - Ongoing - CG2010 0704 Blanket Additional Insured - Completed Operations - CG2037 0704 Blanket Waiver of Subrogation - CG2404 1093 Primary 6 Non-contributory - CFENV98036 1104 Blanket Additional Insured - Umbrella - CFENUO011 1104 Automobile: Blanket Additional Insured - CA7078 0911 Blanket Waiver of Subrogation - CA0444 0310 Workers Compensation: Blanket Waiver of Subrogation - 359B