HomeMy WebLinkAboutLEHER SERVICE 100020 - WC and COIACORO CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DD/YYYY)
07/05/2022
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
Stailey Insurance Corporation
2084 S. Milwaukee Street
Denver CO 80210-
CONTACT Jonathan Hart
PHONE (303)759-2796 FAX (303)759-2960
E-MAIL
jonathan@staileycorp.com
X
COMMERCIAL GENERAL LIABILITY
INSURERS AFFORDING COVERAGE NAIC #
INSURERA:GEMINI INSURANCE COMPANY 10833
VIGPO20275
INSURED
INSURERB:PInnacol Assurance 41190
INSURER C:
Lehrer Services, LLC
INSURER D:
2085 S. Holly Street
INSURER E:
Denver CO 80222-
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
TYPE OF INSURANCE
ADDL
SUBR
POLICY EFF
POLICY EXPLTR
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
VIGPO20275
10/04/202110/04/2022
EACH OCCURRENCE $ 1,000,000
CLAIMS -MADE a OCCUR
DAMAGE TO RENTED $ 100,000
MED EXP (Any oneperson) $ 5,000
PERSONAL & ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
X RO-
POLICY ❑ PRO ❑ LOC
GENERAL AGGREGATE $ 2,000,000
PRODUCTS - COMP/OPAGG $ 2,000,000
$
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT $
(Fa arr. dpnti
BODILY INJURY (Per person) $
ANY AUTO
OWNED SCHEDULED AUTOS ONLY AUTOS
BODILY INJURY (Per accident) $
PROPERTY DAMAGE $
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE $
AGGREGATE $
EXCESS LIAB
CLAIMS -MADE
T
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? IN I
(Mandatory in NH)E.L.
N / A
4131366
05/01/202205/01/2023
X PERTUTE OTH-
FIR
E.L. EACH ACCIDENT $ 1,000,000
DISEASE - EA EMPLOYEE $ 1,000,000
yes, describe under
DESCRIPTION T
E.L. DISEASE -POLICY LIMIT 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
RE: License #100020
L.tK I Irlt A I t 11ULUtK GAN(;tLLA I IUN M1 V1i7777
City of Wheat Ridge
Building & Inspection Services Division
7500 W. 29th Ave.
Wheat Ridge CO 80033 -
ACORD 25 (2016/03)
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
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