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HomeMy WebLinkAboutREPUBLIC SERVICES INC - INSURANCE CERTIFICATE 2023-2024CERTIFICATE OF LIABILITY INSURANCE Page 1 of 6 DATE (MM/DD/YYYY) 06/30/2023 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 CANNON COCHRAN MANAGEMENT SERVICES,INC. 17015 NORTH SCOTTSDALE ROAD SCOTTSDALE,AZ 85255 INSURED REPUBLIC SERVICES,INC. 18500 N.ALLIED WAY PHOENIX,AZ 85054 CONTACT NAME: PHONE (A/C No.Ext): FAX (A/C No.Ext): E-MAIL ADDRESS:certificateteam@ccmsi.com INSURER(S)AFFORDING COVERAGE NAIC # INSURER A:ACE American Insurance Co.22667 INSURER B:Indemnity Insurance Co.of North America 43575 INSURER C:Illinois Union Insurance Company 27960 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 2301830 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 ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE X OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PROJECT LOC OTHER: HDO G47334433 06/30/2023 06/30/2024 EACH OCCURRENCE $5,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence)$5,000,000 MED EXP (Any one person) PERSONAL &ADV INJURY $5,000,000 GENERAL AGGREGATE $30,000,000 PRODUCTS -COMP/OP AGG $20,000,000 A AUTOMOBILE LIABILITY X ANY AUTO X OWNED AUTOS ONLY X SCHEDULED AUTOS X HIRED AUTOS ONLY X NON-OWNED AUTOS ONLY ISA H10735786 06/30/2023 06/30/2024 COMBINED SINGLE LIMIT (Ea accident)$10,000,000 BODILY INJURY(Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) UMBRELLA LIAB OCCUR EXCESS LIAB CLAIMS-MADE DED RETENTION $ EACH OCCURRENCE AGGREGATE B A A A C WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N If yes,describe under DESCRIPTION OF OPERATIONS below N/A WLR C50710397 -AOS WLR C50710324 -OR SCF C5071049A -WI WCU C50710555 -OH XS TNS C66934172 -TX NS/XS 06/30/2023 06/30/2023 06/30/2023 06/30/2023 06/30/2023 06/30/2024 06/30/2024 06/30/2024 06/30/2024 06/30/2024 X PER STATUTE OTHER E.L.EACH ACCIDENT $3,000,000 E.L.DISEASE -EA EMPLOYEE $3,000,000 E.L.DISEASE -POLICY LIMIT $3,000,000 DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Division Number:4642 -Named Insured Includes:Allied Waste Systems,Inc.-Dba:Republic Services of Colorado //Gallegos Sanitation //Gallegos Services -Colorado CERTIFICATE HOLDER CANCELLATION CITY OF FORT COLLINS ATTN:PURCHASING DIVISION PO BOX 580 FORT COLLINS,CO 80522 United States 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 ©1988-2016 ACORD CORPORATION.All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page 2 of 6 AGENCY POLICY NUMBER See First Page CARRIER See First Page NAIC CODE NAMED INSURED REPUBLIC SERVICES,INC. 18500 N.ALLIED WAY PHOENIX,AZ 85054 EFFECTIVE DATE: ADDITIONAL REMARKS CERTIFICATE NUMBER: 2301830 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM. FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE The following provisions apply when required by written contract.As used below,the term certificate holder also includes any person or organization that the insured has become obligated to include as a result of an executed contract or agreement. GENERAL LIABILITY: Certificate holder is Additional Insured including on-going and completed operations when required by written contract. Coverage is primary and non-contributory when required by written contract. Waiver of Subrogation in favor of the certificate holder is included when required by written contract. AUTO LIABILITY: Certificate holder is Additional Insured when required by written contract. Coverage is primary and non-contributory when required by written contract. Waiver of Subrogation in favor of the certificate holder is included when required by written contract. WORKERS COMPENSATION AND EMPLOYERS LIABILITY: Waiver of Subrogation in favor of the certificate holder is included when required by written contract where allowed by state law. Stop gap coverage for ND and WA is covered under policy no.WLR C50710397 and stop gap coverage for OH is covered under policy no.WCU C50710555,as noted on page 1 of this certificate. TEXAS EXCESS INDEMNITY AND EMPLOYERS LIABILITY: Insured is a registered non-subscriber to the Texas Workers Compensation Act.Insured has filed an approved Indemnity Plan with the Texas Department of Insurance which offers an alternative in benefits to employees rather than the traditional Workers'Compensation Insurance in Texas.The excess policy (TNS C66934172)shown on this certificate provides excess indemnity and Employers Liability coverage for the approved Indemnity Plan. Contractual Liability is included in the General Liability and Automobile Liability coverage forms.The General Liability and Automobile Liability policies do not contain endorsements excluding Contractual Liability. Separation of Insured (Cross Liability)coverage is provided to the Additional Insured,when required by written contract,per the Conditions of the Commercial General Liability Coverage form and the Automobile Liability Coverage form. Additional insured includes:City of Fort Collins,its officers,agents and employees,when required by written contract. ACORD 101 (2008/01) ©1988-2010 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD Page 3 of 6 Page 4 of 6 Page 5 of 6 Page 6 of 6