Loading...
HomeMy WebLinkAboutNOVOTNY ELECTRIC LLC - INSURANCE CERTIFICATE (10)NOVOT-1 OP ID: P6 ,44coR0" CERTIFICATE OF LIABILITY INSURANCE `—� DATE (MMIDDfYYYY) F 11 /0/206 16 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 Brown & Brown Inc 4532 Boardwalk Dr, Suite 200 Fort Collins, CO 80525 House Account CONTACT House Account NAME: ACNN. El:970-482-7747 IF No; 970-484-4165 E-MAIL ADDRESS: INSURERS) AFFORDING COVERAGE NAIC N INSURER A: Westfield Insurance Company 24112 INSURED Novotny Electric LLC INSURER B : Pinnacol Assurance Company 41190 530 Ruby Drive Fort Collins, CO 80525 INSURERC: - INSURER D : INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 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. INSR LTR TYPE OF INSURANCE DDL D UB WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FXIOCCUR CWP7961490 10/23I2016 10/23l2017 EACH OCCURRENCE $ 1,000,000 DAMAGE TO R 'u- PREMISES Ea occurrence $ 500,00 MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- ❑ JECT LOC OTHER: GENERAL AGGREGATE $ 2,000,00 PRODUCTS -COMP/OP AGG $ 2,000,00 $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS CWP7961490 10123=16 10/23/2017 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 $ $ $ $ BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CWP7961490 10/23/2016 10/23/2017 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,00 DED X I RETENTION $ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPFR_ATIONS below N / A 4177813 10/01/2016 10/01/2017 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEO - $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) FAX: 970-224-6134 GtK I II-IGA I t HULUtK GANGtLLA I IUN CITYFC2 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. PO Box 580 Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD NOVOT-1 PAGE 2 NOTEPAD INSURED'S NAME Novotny Electric LLC OP ID: P6 Date 11/03/2016 eld General Liability 10-23-15/16 includes the following blanket ements that would apply if required by written contract: Additional Insured Ongoing Operations CG2010 4/13 Additional Insured Completed Operatiosn CG2037 4/13 Per Project Aggregate CG2503 5/09 Per Location Aggregate CG2504A 5/09 Waiver of Subrogation CG7137 11/12 Primary/Non-Contributory CG7137 11/12 Commercial Auto Policy includes blanket endorsement form CA7077 9/11 that includes blanket additional insured Blanket waiver of subrogation if required by written contract included policy form CA0444 3/10 Pinnacol Workers Compensation policy includes blanket waiver of subrogation, policy form 359B, if required by written contract Umbrella follows form.