Loading...
HomeMy WebLinkAboutNOVOTNY ELECTRIC LLC - INSURANCE CERTIFICATE (7)-� NOVOT-1 OP ID: P6 ACORO� 71T101/28/2015 (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE MMID/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 CONTACT NAME: House Account _ Brown & Brown Inc PHONE 970-482-7747 FA No ; 970�84-4165 4532 Boardwalk Dr, Suite 200 A/c No El Fort Collins, CO 80525 E-MAIL House Account ADDRESS: INSURERS AFFORDING COVERAGE NAIL N INSURER A: Westfield Insurance Company 24112 INSURED Novotny Electric LLC INSURERS:Pinnacol Assurance Company 41190 530 Ruby Drive Fort Collins, CO 80525 iNsuRERc: INSURER D : INSURER E : INSURER F : r_r1VFaer_Fc r1=RT11:1reTF NI IMRFR• RFVI-glnN NI IMRFR- 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 -- -- AD L UBR _ POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE T OCCUR CWP7961490 10/23/2015 10/23/2016 DAMAGE PREMISES Ea occurrence) $ 500,00 MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 PRO - POLICY X ECT X LOC PRODUCTS - COMP/OP AGG $ 2,000,00 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) _ $ A X ANY AUTO CWP7961490 10/23/2015 10/23/2016 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS X UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 1,000,00 AGGREGATE A EXCESS LIAB CLAIMS -MADE CWP7961490 10/23/2015 10/23/2016 $ 1,000,00 DED X I RETENTION $ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Y❑ (Mandatory in NH) N / A 4177813 10/01/2015 10/01/2016 X I PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 500,00 E.L. DISEASE - EA EMPLOYEE $ 500,00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) FAX: 970-224-6134 rF0TICIr ATF LIl11 r111=0 rANrFI I ATI()N CITYFC2 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 Fort Collins PO Box 580 AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD NOVOT-1 PAGE 2 NOTEPAD INSURED'S NAME Novotny Electric LLC OP ID: P6 Date 10/28/2015 tfield General Liability 10-23-15/16 includes the following blanket orsements that would apply if required by written contract: dditional Insured Ongoing Operations CG2010 4/13 dditional Insured Completed Operatiosn CG2037 4/13 er Project Aggregate CG2503 5/09 er Location Aggregate CG2504A 5/09 aiver of Subrogation CG7137 11/12 rimary/Non-Contributory CG7137 11/12 nacol Workers Compensation policy includes blanket waiver of rogation, policy form 359B, if required by written contract