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HomeMy WebLinkAboutENVIROSTAR INC - INSURANCE CERTIFICATEWESTSTA-06 PKUMAR ACORO CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY)7/6/2017 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 have ADDITIONAL INSURED provisions or 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 License # 0757776 cEACT Concord, CA - HUB International Insurance Services Inc. PHONE - FAX 2300 Clayton Rd. (A/C, Ext: ( 925 ) 6096500 A/c. No):(925 ) 609-6550 Concord, CA 94520 INSURE S AFFORDING COVERAGE NAIC # INSURER A: Liberty Mutual Fire Insurance Company 23035 INSURED INSURER B: LibertyInsurance Corporation 42404 EnviroStar, Inc. INSURER c : Berkshire Hathaway Homestate Insurance Company 200" Martin Ray Laundry Systems, Inc. 290 N.E. 68th Street INSURER D :Continental Divide Insurance Company 35939 Miami, FL 33138 INSURERE: rnvcoer_GC CFRTIF!C- TE NUMBER: REVISION NUMBER: vTHIS IS TOCERTIFYTHAT 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 TYPE OF INSURANCE ADDLISUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7 OCCUR �( BI/PD Ded: 25,000 TB2Z61065325107 07/01/2017 07/01/2018 EACH OCCURRENCE 1 $ 1,000,000 DAMAGE To RENTED REM aoccurrence) 300,600 X MED EXP An one person)5,000 PERSONAL & ADV INJURY $ 1,000,000 _ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY j 7X LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OP AGG 2,000,000 A AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HID NON -OWNED Al S ONLY AUTOS ONLY AS2Z61065325027 07/01/2017 07/01/2018 COMBINED SINGLE LIMIT a accident) 11000,000 $ BODILY INJURY Perperson) $ I BODILY INJURY Per accident P�20PERTY AMAGE er accident _ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE TH7Z61065325067 07/01/2017 07/01/2018 EACH OCCURRENCE 51000,000 AGGREGATE 5,000,000 DED X RETENTION$ 10,000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITYYIN ANY PROPRIETOR/PARTNER/EXECUTIVE L OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WEWC806499 07/01/2017 07/01/2018 X STATUTE ERH E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYE 1 �QQQ�QQQ $ E.L. DISEASE -POLICY LIMIT 1000000 $ ' ' D 'Work Comp -Statutory WEWC806500 07/01/2017 07/01/2018 Empl Liab Limits 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Policy #WEWC806499 covers employees in states of AZ, CA, CO, FL, NM. Policy #WEWC806500 covers employees In state of OR. The City of Fort Collins, its officers, agents and employees as Additional Insured as respects General Liability per attached form LCO443 0512, as required by written contract. Umbrella Liability follows form. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Purchasing Dept. P.O. Box 580 Fort Collins, CO 80522 AUTHORIZED REPR�ESE�NTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD