HomeMy WebLinkAbout507709 SERVPRO OF FORT COLLINS - INSURANCE CERTIFICATE (3)AC40R!>►� CERTIFICATE OF LIABILITY INSURANCE
l-'"'
DATE (MM/DD/YYYY)
03/07/2018
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
Doug Jones
c/o Artex Risk Solutions, Inc.
8840 E. Chaparral Rd.; Suite 275
CONTACT
NAME:
PHONE FAX
Arc No Ext): (480) 951 4177 (A/c,No: (480) 951-4266
ADDRESS: SDI-.BSD.Certificates@artexrisk.com
INSURERS) AFFORDING COVERAGE
NAIC #
Scottsdale, AZ 85250
INSURER A: American Zurich Insurance Company_
40142
INSURED
Avitus, Inc. dba: Avitus Group Alt, Emp: D&A Enterprises, Inc. dba: Servpro of Fort
Collins
INSURER B :
INSURER C : —
INSURER D :
175 N. 27th Street, Suite 800 PO Box 2506
Billings, MT 59103
INSURER E
INSURER F :
COVERAGES CERTIFICATE NUMBER:18MT901815020 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.
POLI—CPOLICY----- -
ILT R ! TYPE OF INSURANCE DL SUBR POLICY NUMBER MM/DD�YF MM/ D/YYYP LTR LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$
CLAIMS -MADE n OCCUR
D E TO
PREEMIMI SES Ea occurrence
$
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$
GENT
AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$
POLICY 1 PRO-
JECT D LOC
PRODUCTS - AGG
1 $
_COMP/OP
$
OTHER:
AUTOMOBILE
_
LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$
I ANY AUTO
BODILY INJURY (Per person)
$
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
L
$
UMBRELLA LIAB
I
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
DIED RETENTION $
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANYPROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? ❑
N/A
WC 40-19-885-13
04/01/2018
04/01/2019
X PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYE
a 1,000,000
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
Location Coverage Period:
04/01/2018
04/01/2019
Client# 905-CO
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
D&A Enterprises, Inc. dba: Servpro of Fort Collins
Coverage is provided for
only those co -employees 308 N. Link Lane
of, but not subcontractors Fort Collins, CO 80524
to:
1 rYIL;A It HtJLUtR
City of Fort Collins
215 N Mason St
Fot Collins, CO 80521
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
1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and loco are registered marks of ACORD