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HomeMy WebLinkAbout463182 THE DAVEY TREE EXPERT COMPANY - INSURANCE CERTIFICATE (14)-�1 ® ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMDDNYYY) 08/28/2015 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 MARSH USA INC. 200 PUBLIC SQUARE, SUITE 1000 CLEVELAND, OH 44114-1824 Attn: Cleveland.CertRequest@malsh.com CONTACT NAME: PHONE FAX A/c No): E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: Old Republic Insurance Company 24147 138731 RESICA INSURED THE DAVEY TREE EXPERT COMPANY INSURER B : 1500 N. MANTUA ST INSURER C : INSURER D: KENT,OH 44240 INSURER E : INSURER F : rrrir,crn wrc &J"RAMCM. ra F-Ialaiah4/%-%N wi-VISHIN NIIMml-w-a VV�lrV1V VV vr.� .. ��• 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 ADDL SUER POLICY NUMBER MM DD/YYY Y EXP MM DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY 305146 09/01/2015 09/01/2016 EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE 1fl OCCUR DAMA E T RENTED PREMISES Eaorxunence $ 2,000,000 MED EXP (Any we person) $ 5,000 PERSONAL 8 ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 2,000,000 POLICY PRO ❑JECT❑LOC OTHER: A AUTOMOBILE LIABILITY MWTB 305144 09/01/2015 09/01/2016 COMBINED SINGLE LIMIT Ea accident $ 2,000,000 BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED HESCDULED AUTOSAUTOS NON -OWNED HIRED AUTOS X AUTOS Ix PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ Ld AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS below N I A MWC 30514300 (ADS) 09/01/2015 09/01/2016 TH X I STATUTE ER E.L. EACH ACCIDENT $ S,000,OOO E.L. DISEASE - EA EMPLOYE $ S,000,OOO E.L. DISEASE -POLICY LIMIT $ 5,000,000 A EXCESS WORKERS COMPENSATION MWXS 305145 (CA, OH, NC, PA, WA) 9/01/2016 WORKERS COMPENSATION STATUTORY EXCESS OF $5,000,000 SIR T��7 EMPLOYERS LIABILITY $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) 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 ATTN: PURCHASING 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 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Luann M. Glavac di44L ' OPI /!' � V 1`JOD4u14 A1`UKU VVKrUKALIVn. MlI nynm laaclvau. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 08670 LOC #: Cleveland ACORO® ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY MARSH USA INC. NAMED INSURED THE DAVEY TREE EXPERT COMPANY 1500 N. MANTUA ST KENT, OH 44240 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers Compensation does not apply in MN. Coverage is obtained from Workers Compensation Reinsurance Association (W.C.R.A.) as required by the state. Minnesota Employers Liability is covered by policy number MWC 30514300. Excess Workers Compensation excludes the Care of Trees, Wolf Tree, and Wetland Studies. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD