Loading...
COI - Davey Tree Surgery Company - Expires 2022-09-01ACORU® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) ikh . " 08/20/2021 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 Marsh USA Inc. CONTACT NAME: PHONE A XC No): 200 Public Square, Suite 3760 E-MAIL ADDRESS: Cleveland, OH 44114-1824 Attn: Cleveland.CertRequest@marsh.com INSURERS AFFORDING COVERAGE NAIC # INSURER A. Old Republic Insurance Company 24147 274403 SURGE Coyle INSURED Davey Tree Surgery Company INSURER 8 : 2617 South Vasco Road INSURER C : INSURER D P.O. Box 5015 Livermore, CA 94551-5015 NSURER E: rNSURER F : COVERAGES CERTIFICATE NUMBER: CLE-006428300-10 REVISION NUMBER: 2 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 UBR POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY 314042 21 09101/2021 09101/2022 EACH OCCURRENCE $ 5,000,000 CLAIMS -MADE FIOCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 5,000,000 MED EXP (Any one person) $ 25,000 PERSONAL & ADV INJURY $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 POLICY PRO LOC JECT X PRODUCTS - COMP/OP AGG $ 5,000,000 $ OTHER: A AUTOMOBILE LIABILITY MWTB 314041 21 09/0112021 09/01/2022 COMBINED SINGLE LIMIT Ea accident $ 5,00, 0000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y 1 N ANYPROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? a (Mandatory in NH) N I A MWC 314045 21 09J01J2022 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 5,000,000 E.L. DISEASE - EA EMPLOYEE $ 5,000,000 If es, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 5,000,000 A Excess General Liability MWZX 314044 21 09/01/2021 09/0112022 Each Occurrence 7,500,000 Aggregate 7,500,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached H more space Is required) Re: Entry to Las Animas Veterans Park for Tree Work City of Gilroy, its officers, officials and employees is(are) included as Additional Insured(s) as respects General 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 Gilroy, its officers, officials and employees SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 7351 Rosanna Street ACCORDANCE WITH THE POLICY PROVISIONS. Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE O 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD G)w0C) Ul 0 o �l >�:� co m CL o Cn:3 m� C)57o m a N N PM u AGENCY CUSTOMER ID: CN101565730 LOC #: Cleveland ACORO® ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh USA Inc. Davey Tree Surgery Company 2617 South Vasco Road P.O. Box 5015 POLICY NUMBER Livermore, CA 94551-5015 CARRIER NAIC CODE EFFECTIVE DATE: "1111110H f_l III THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, I FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Excess Workers Compensation (NC,OH,PA,WA) Insurer Affording Coverage: Old Republic Insurance Company Policy Number: MWXS 314043 21 Effective Date: 09/01/2021 Expiration Date: 09/0112022 Workers Compensation: Statutory Employer's Liability: $1,000,000 SIR: $5.000,000 Excess Workers Compensation (CA) Insurer Affording Coverage Old Republic Insurance Company Policy Number: MWXS 316391 21 Effective Date: 09/0112021 Expiration Date: 09/0112022 Workers Compensation: Statutory Employer's Liability: $1,000,000 SIR: $5,000,000 The Excess General Liability policy no. MWZX 314044 21 follows the coverage terms of the primary General Liability policy no. MWZY 314042 21. ACORD 101 (2008101) 0342-01-00-0002816.0002-0006421 © 2008 ACORD CORPORATION. All rights i The ACORD name and logo are registered marks of ACORDWE Dear Certificate Holder: As many companies have moved to a remote working environment, mailing Certificates of Insurance to a physical address can cause unnecessary delays in providing you proof of insurance. To streamline delivery and in an effort to support our firm's commitment to sustainability, going forward, we would like to distribute your Certificates of Insurance electronically if possible. We are kindly requesting Certificate Holders provide us an email address where we can deliver your COI in the future. Tease send your response to. USOperations.email 12marsh.com and provide the following information so that we can expedite your COI delivery. * Certificate #f (Shown below Insured Name -- e.g.; ABC-123456789-01) • E-Mall for future delivery: For undeliverable email addresses, our system is configured to automatically redirect the Certificate for delivery via USPS. Lastly, if you no longer need this COI please respond to USOperations.email@marsh.com with the Certificate number and we will inactive the record in our system to avoid future automatic delivery. Thank you. US Operations, Marsh USA, Inc.