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HomeMy WebLinkAbout463182 THE DAVEY TREE EXPERT COMPANY - INSURANCE CERTIFICATE (15)A�!eO CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 08128/2015 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 CONTACT NAME: PHONE FAX (A/C. No Ext1; CLEVELAND, OH 44114-1824 Attw Cleveland.CertRequest@marsh.com E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: Old Republic Insurance Company 24147 120930 RESOU NUTT INSURED DAVEY RESOURCE GROUP, A DIVISION OF INSURER 8 THE DAVEY TREE EXPERT COMPANY INSURER C : 1500 N. MANTUA ST. KENT, OH 44240 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: CLE-004360109-03 REVISION NUMBER:2 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 SUBR POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY 305146 09/01/2015 09/01/2016 EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 2,000,000 MED EXP (Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ❑ PRO JECT ❑ LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER A AUTOMOBILE LIABILITY MWTB 305144 09/01/2015 09/01/2016 COMBINED SINGLE LIMIT Ea accident)2,000,000 $ BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS PROPERTY DAMAGE Per accident $ X X NON -OWNED HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAB DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANY PROPRIETOR/PARTNER/EXECUTIVE � OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA MWC 30514300 (AOS) 09/01/2015 09/01/2016 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 5,000,000 E.L. DISEASE - EA EMPLOYEE -- — $ 5,000.000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 5,000,000 A EXCESS WORKERS COMPENSATION MWXS 305145 (CA, OH, NC, PA, WA) 09/01/2015 09/01/2016 WORKERS COMPENSATION STATUTORY EXCESS OF $5,000,000 SIR EMPLOYERS LIABILITY $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) THE CITY, ITS OFFICERS, AGENTS AND EMPLOYEES 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. l"aa112L•L•\I;0:Lai Alli4 10 Lei A IR v I 11.911 CITY OF FORT 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 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Luann M. Glavac *"j 0�i @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 08670 LOC #: Cleveland 'REP AGENCY MARSH USA INC. POLICY NUMBER CARRIER ADDITIONAL REMARKS SCHEDULE NAIC CODE NAMED INSURED DAVEY RESOURCE GROUP, A DIVISION OF THE DAVEY TREE EXPERT COMPANY 1500 N. MANTUA ST, KENT, OH 44240 EFFECTIVE DATE: AUUI I IUNAL KtMAKK5 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Page 2 of 2 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. HVUKU 1U1 (zUUtslul) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD