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HomeMy WebLinkAbout463182 THE DAVEY TREE EXPERT COMPANY - INSURANCE CERTIFICATE (16)AC"�® CERTIFICATE OF LIABILITY INSURANCE DATE /YYYY) �/A /2o17 o612a/2017 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' MARSH USA INC. PHONE FAX 200 PUBLIC SQUARE, SUITE 3760 fA/C. No. Ent): _ A/C No : - E-MAIL CLEVELAND, OH 44114-1824 Attn: Cleveland. CertRequest@marsh.com ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: Old Republic Insurance Company 24147 138731 RESICA HILL INSURED THE DAVEY TREE EXPERT COMPANY INSURER B : INSURER C : 1500 N MANTUA STREET KENT, OH 44240 INSURER D _ INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: CLE-005892375-15 REVISION NUMBER: 1 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 ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY 310964 09/01/2017 09/01/2018 EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE � OCCUR _ _ TE PREMISES Ea occurrence) $ 2,000,000 MED EXP (Any one person) $ 5,000 PERSONAL& ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 PRO❑LOC JECT X PRODUCTS -COMP/OP AGG $POLICY 2,000,000 $ OTHER. A AUTOMOBILE LIABILITY MWfB 310963 09/01/2017 09/01/2018 COMBINED SINGLE LIMIT jEa accident)__ $ 2,000,000 X BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? � (Mandatory in NH) N/A MWC 31096200 (ADS) 09/01/2018 X PER oTH- STATUTE ER E.L. EACH ACCIDENT $ 5,000,000 E.L. DISEASE - EA EMPLOYEE $ 5,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 5,000,000 A EXCESS WORKERS COMPENSATION MWXS 310965 (CA,OH,PA,NC,WA) 09/01/2017 09/01/2018 WORKERS COMPENSATION STATUTORY EXCESS OF $5,000,000 SIR EMPLOYERS LIABILITY $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) THE CITY, ITS OFFICERS, AGENTS, AND EMPLOYEES IS(ARE) INCLUDED AS ADDITIONAL INSURED(S) AS RESPECTS GENERAL LIABILITY AND AUTOMOBILE LIABILITY WHERE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT AND ONLY AS RESPECTS OPERATIONS PERFORMED ON THEIR BEHALF BY THE NAMED INSURED. CERTIFICATE HOLDER CANCELLATION CITY OF FT. COLLINS ATTN: PURCHASING PO BOX 580 FORT COLLINS, CO 80524 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Luann M. Glavac 0(4-1 A - - 4*7 /jar-►+.rt� ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 08670 LOC #: Cleveland qC0 AnnITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED MARSH USA INC. THE DAVEY TREE EXPERT COMPANY 1500 N MANTUA STREET POLICY NUMBER KENT, OH 44240 CARRIER I NAIC CODE EFFECTIVE DATE: AUUI I IUIVAL KtMAKKb THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers Compensation does not apply in MN Coverage is obtained from Workers Compensation Reinsurance Association (W.C.R.A.) as required by the state. Minnesota Employers Liability is covered by policy number MWC 31096200 The Excess Workers Compensation policy does not include The Care of Trees, Inc., Welland Studies and Solutions, Inc.; Arborguard, Inc. or Wolf Tree, Inc. Page 2 of 2 ACORD 101 (2008101) V [UUt$ At,UML) t,UKrUKA I IV PC MI F19I I LS IUb VIYCU The ACORD name and logo are registered marks of ACORD