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HomeMy WebLinkAboutNOVOTNY ELECTRIC LLC - INSURANCE CERTIFICATE (9)`-� NOVOT-1 OP ID: P6 ACORO' r ATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE TE(MMI DNY 017 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 NAME: House Account Brown & Brown Inc PHONE FAX 4532 Boardwalk Dr, Suite 200 A/c No Ell: 970-482-7747 (A/C, No): 970-484-4165 Fort Collins, CO 80525 E-MAIL House Account ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: Plnnacol Assurance Company 41190 INSURED Novotny Electric LLC INSURER B: Westfield Insurance Company 24112 6874 N Franklin St. Loveland, CO 80538-1179 INSURERC: INSURER D : INSURER E : INSURER F : (Tf)VFRA(:FS rFRTIFIRATF NI IMRFR• RFVISION 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 ADDLSUBR D POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP LIMITS MM/DD/YYYY B X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE )(1 OCCUR CWP7961490 10/23/2017 10/23/2018 EACH OCCURRENCE $ 1,000,00 TO DAMAGES( RENTED PREMISES Ea occurrence) $ 500,00( MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO ❑ LOC JECT OTHER GENERAL AGGREGATE $ 2,000,00 PRODUCTS - COMP/OP AGG $ 2,000,00 $ B AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS CWP7961490 10/23/2017 10/23/2018 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CWP7961490 10/23/2017 10/23/2018 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,00 DED X RETENTION $ O $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y� OFFICER/MEMBER EXCLUDED> (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 4177813 10/01/2017 10/01/2018 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 500,00 E.L. DISEASE - EA EMPLOYEE $ 500,00 E.L. DISEASE - POLICY LIMIT 1 $ 500,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) FAX: 970-224-6134 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 09/12/2017 stfield General Liability 10-23-17/18 includes the following blanket dorsements 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 10/13 that includes blanket additional insured Blanket waiver of subrogation if required by written contract included policy form CA0444 10/13 Pinnacol Workers Compensation policy includes blanket waiver of (subrogation, policy form 359B, if required by written contract la follows form.