HomeMy WebLinkAbout605890 WESTERVELT COMPANY - INSURANCE CERTIFICATE (2)Certificate of Insurance
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON YOU THE CERTIFICATE. HOLDER. THIS CERTIFICATE IS NOT AN
INSURANCE POLICY AND DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW, POLICY LIMITS .ARE NO LESS THAN THOSE
LISTED, ALTHOUGH POLICIES MAY INCLUDE ADDITIONAL SUBLIMIT/LIMITS NOT LISTED BELOW.
This is to Certify that
I The Westervelt Company
& as per Named Insured Endorsement 1 NAME AND
PO Box 48999 ADDRESS
Tuscaloosa AL 35404-8999 OF INSURED
II
L J
Libel Mutual.
INSURANCE
is, at the issue date of this certificate, insured by the Company under the policy(ies) listed below. The insurance afforded by the listed policy(ies) is subject to all their terms, exclusions and
Conditions and is not altered by any requirement, tern or condition ofany contract or other document with respect to which this certificate may be issued.
EXP DATE
TYPE OF POLICY
❑ CONTINUOUS
❑ EXTENDED
POLICY NUMBER
LIMIT OF LIABILITY
Q POLICY TERM
WORKERS
COMPENSATION
6/30/2019
WA7-65D-434151-238
COVERAGE AFFORDED UNDER WC
LAW OF THE FOLLOWING STATES:
-238: All States Except: OH, WA,
ND, WY
EMPLOYERS LIABILITY
Bodily Inju b Accident
5y00 OOOE h Accid=
Bodily Injury By Disease
$500 000
WA7-65D-434151-258
-258: CA
Employers Liability: $1,000,000
Bodily Injury By Disease
500 000 Each Person
COMMERCIAL
GENERAL LIABILITY
6/30/2019
T82-651-434151-028
General Aggregate
$2,000,000
Products / Completed Operations Aggregate
OCCURRENCE
❑ CLAIMS MADE
$2,000,000
Each Occurrence
$1 000 000
Personal & Advertising Injury
$1 , OOO, OOO Per Person /Organization
RETRO DATE
OtherDama e remises rented toTl�heredical
Expense:
0
00
AUTOMOBILE
LIABILITY
6/30/2019
AS2-651 434151-038
Each Accident —Single Limit
$2,000,000 B.I. And P.D. Combined
0 OWNED
Each Person
Each Accident or Occurrence
QNON -OWNED
HIRED
Each Accident or Occurrence
OTHER
ADDITIONAL COMMENTS
The City of Fort Collins is included as additionally insured with respect to General Liability and Auto Liability as required by written contract
" If the certificate expiration date is continuous or extended tern, you will be notified if coverage is terminated or reduced before the certificate expiration date.
NOTICE OF CANCELLATION: (NOT APPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW.)
BEFORE THE STATED EXPIRATION DATE THE COMPANY WILL NOT CANCEL OR REDUCE THE
INSURANCE AFFORDED UNDER THE ABOVE POLICIES UNTIL AT LEAST 30 DAYS NOTICE
OF SUCH CANCELLATION HAS BEEN MAILED TO:
Liberty Mutual
Insurance Group
City of Fort Collins
/
PO BOX 580
Tammy Scipio
Fort Collins CO 80522
Lawrenceville / 0505 AUTHORIZED REPRESENTATIVE
�3
y =
2530 Sever Road, Suite 200
Lawrenceville GA 30043-4024 770-814-9002 7/2/2018
IOFFICE
PHONE DATE ISSUED
This certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurance as is afforded by those Companies NM 772 07-10
42954037 1 U1 836 1 6/18-6/19 - All Lines I Linda Bradfish 1 7/2/2018 2:44:03 PM (CDT) I Page 1 of 2
LDI COI 268896 02 11