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HomeMy WebLinkAbout106253 SERVICEMASTER OF FORT COLLINS - INSURANCE CERTIFICATE (4)HSINC-1 OP ID: JY CERTIFICATE OF LIABILITY INSURANCE r ATE(MM/DDYYYY) 05/31 /2018 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 Karen E. Siwek, CPA NAME:Brown & Brown Inc PHONE FAX 4532 Boardwalk Dr, Suite 200 aC No E:t :970-482-7747 A/c No): 970-484-4165 Fort Collins, CO 80525 E-MAIL Karen E. Siwek, CPA ADDRESS: certificates@bbcolorado.com INSURER A:Pinnacol Assurance Company 41190 INSURED HS, Inc. dba ServiceMaster INSURER B: American Risk Mgmt Resources of Fort Collins dba ServiceMaster of Loveland dba INSURER C: Westfield Insurance Company 24112 ServiceMaster Solutions INSURER D: Philadelphia Indemnity Ins Co 18058 3054 Lake Canal Ct #120 Fort Collins, CO 80524 INSURER E: INSURER F : CnVFRAGFR CFRTIFICATF NIIMRFR- RFVISInN 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 LTR TYPE OF INSURANCE AD L UBR POLICY NUMBER ICY EFF MMLDDYY Y POLICY EXP MMIDD YYYY LIMITS B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE Al OCCUR EPK-122893 06/01/2018 06/01/2019 DAMAGE TO RENTED PREMISES Ea occurrence $ 50,00 X MED EXP (Any one person) $ 5,00 Pollution/Mold EPK-122893 06/01/2018 06/01/2019 X CPL/Professional PERSONAL & ADV INJURY $ 1,000,00 EPKA22893 06/01/2018 06/01/2019 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY JECT LOC X PRODUCTS - COMP/OP AGG $ 2,000,00 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,00 BODILY INJURY (Per person) C ANY AUTO CWP6099227 06/01/2018 06/01/2019 $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,00 AGGREGATE $ 2,000,00 B EXCESS LIAB CLAIMS -MADE EFX-110786 06/01/2018 06/01/2019 DED X I RETENTION $ 10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N 4166362 06/01/2018 06/01/2019 X PER I OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A E.L. DISEASE - EA EMPLOYEE $ 11000100 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000 00 $ , C Leased/Rented Eq CWP6099227 06/01/20111 16/01/2019 Lsd/Rntd 25,00 D Cyber Liab TBD 06/01/2018 06/01/2019 �Cyber 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) CERTIFICATE CITYOFF City of Ft. Collins 215 N Mason St 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 Karen E. Siwek, CPA © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD HSINC-1 NOTEPAD INSURED'S NAME HS, Inc. dba ServiceMaster OP ID: JY PAGE 2 Date 05/31 /2018 required by written contract the following may apply: neral Liability: anket Additional Insured - anket Additional Insured - anket Waiver of Subrogation imary 6 Non -Contributory tomobile Liability: anket Additional Insured anket Waiver of Subrogation rkers Compensation: anket Waiver of Subrogation Ongoing Operations Completed Operations