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HomeMy WebLinkAboutWILLMARK ENTERPRISES INC - INSURANCE CERTIFICATE (5)A��R D® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDlYYYY) 06/22/2018 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 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 CONTACT NAME: Brandie Zuckerman Moody Insurance Agency, Inc. (PH(303)824-6600 FAAicNo: (303)370-0118 8055 East Tufts Avenue E-MAIL brandie.zuckennan@moodyins.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # Suite 1000 INSURERA: Cincinnati Insurance Companies 2000 Denver CO 80237 INSURED INSURER B : Plnnacol Assurance 41190 INSURERC : Willmark Enterprises Inc INSURER D : P O BOX 120 INSURER E : INSURER F : Firestone CO 80520 COVERAGES CERTIFICATE NUMBER: 18-19 Master REVISION NUMBER: 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. ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM DDIYYYY MMDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE500,000 PREMISES Ea occurrence $ MED EXP (Any one person) $ 10.000 PERSONAL & ADV INJURY $ 1,000,000 A Y ENP0444642 07/01/2018 07/01/2019 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECOT- LOC HOTHER: PRODUCTS-COMP/OPAGG $ 2,000,000 Employee BenefitLiability s AUTOMOBILE LIABILITY COMEaaccBINEDSINGLE LIMIT ident) $ 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS ENP0444642 07/01/2018 07/01/2019 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY Comp/Collision Ded s 1,000 X UMBRELLA LIAB X1 OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 A EXCESS LIAB CLAIMS -MADE ENP0444642 07/01/2018 07/01/2019 DED I X1 RETENTION $ 0 $ B WORKERS COMPENSATION EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA 4059734 07/01/2018 07/01/2019 STATUTE X STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 Contractors Equipment 104,282 A Contractors Equipment ENP0444642 07/01/2018 07/01/2018 Deducitble 1,000 Installation Floater 25,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) City of Fort Collins is included as additional insured, per written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. 300 LaPorte Ave AUTHORIZED REPRESENTATIVE Fort Collins CO 80521 ' n © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD COMMENTS/REMARKS CONTRACTUAL LIABILITY APPLIES PER POLICY TERMS AND CONDITIONS GA 233 CO 0511 Form Attached Includes: General Liability Blanket Additional Insured for Ongoing and Completed Operations When Required By Written Contract Blanket Waiver of Subrogation When Required By Written Contract Blanket Primary and Non -Contributory Status When Required By Written Contract Per Project Aggregate When Required By Written Contract AA 4171 1105 Form Attached Includes Commercial Auto Blanket Additional Insured Status When Required By Written Contract AA 4172 0909 Form Attached Includes Commercial Auto Blanket Waiver of Subrogation When Required By Written Contract AA 4174 1105 Form Attached Includes Commercial Auto Blanket Primary and Non -Contributory Status When Required By Written Contract Umbrella Policy Will Follow Form over General Liability and Automobile Liability for Additional Insured, Waiver of Subrogation and Primary and Non -Contributory Status. Workers Compensation Blanket Waiver of Subrogation When Required By Written Contract **Please Note hard copies of endorsements will not accompany mailed certificates. All electronic delivery will include all forms. Please email certrequest@moodyins.com to receive a copy and for furture distributions.** RECEIVED JUL 032018 City Manager's Office I OFREMARK COPYRIGHT 2000, AMS SERVICES INC. I