HomeMy WebLinkAboutJACO - INSURANCE CERTIFICATEACORD,M CERTIFICATE OF
DATE
LIABILITY INSURANCE page 1 at 2
09/20/2006
PRODUCER 877-945-7378
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Willie North America, Inc.
26 Century Blvd.
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
P. 0. Box 305191
Nashville, TN 372305191
INSURERS AFFORDING COVERAGE
NAIC#
INSURED JACO Environmental, Inc.
INSURERA: Lexington Insurance Co.
19437-000
PO Box 1478
Snohomish, WA 98291
INSURER B: St. Paul Fire and Marine Insurance Campea
24767-001
INSURERC: Commerce and Industry Insurance Company
19410-003
INSURERD:American International Specialty Lines In
26883-002
INSURER E:
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
ADDI
TYPE OF INSURANCE
POLICY NUMBER
POLICYEFFECTIVE
POLICY EXPIRATION
LIMITS
A
GENERAL LIABILITY
7351449
9/15/2006
9/15/2007
EACHOCCURRENCE
$ 2,000,000
PAR EAMI ETO eENTEre
$ 1,000,000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE ® OCCUR
MED EXP (Anyone person)
$
PERSONAL&ADV INJURY
$ 11000,000
X WA Stop Gap Included
$
$10, 000 Deductible
GENERAL AGGREGATE
$ 2,000,000
GENT AGGREGATE LIMIT APPLIES PER:
PRODUCTS -COMP/OPAGG
$ 2,000,000
$ POLICY 7 PRO LOC
LE
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULEDAUTOS
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY -EA ACCIDENT
$
OTHERTHAN EAACC
$
ANYAUTO
$
AUTO ONLY: AGG
B
EXCESSLIABILITY
QK08400048
9/15/2006
9/15/2007
EACHOCCURRENCE
$ 4,000,000
X OCCUR CLAIMS MADE
AGGREGATE
$ 4.000.000
$
DEDUCTIBLE
$
X RETENTION $ 10.00(
G.
C
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOWPARTNER/EXECUTIVE
ADS WC3421557
CA NC3421558
2/28/2006
2/28/2006
2/28/2007
2/28/2007
g WCSTATU- OTH-
E.L. EACH ACCIDENT
$ 11000,000
E.L.DISEASE-EAEMPLOYEE
$ 1,000,000
OFFICERIMEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE -POLICY LIMIT
1 $ 1,000,000
D
OTHER
1361078
9/15/2006
9715 2007
Pollution Legal Liability
$1,000,000 Per Incident
including BI/PD 8 Cleanup
$2,000,000 Aggregate
S25,000 Deductible, Each Incident
DESCRIPTION OF OPERATONS/LOCATIONS/VENICLESIERCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
Workers' Compensation AOS policy includes Utah and Oregon only.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 0 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
City of Fort Collins IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Purchasing Division
Attn: Christine Patterson -Jarvis REPRESENTAIWES.
700 Wood Street AUTHORI REPRESENTATMr'%
Fort Collins, CO 80522-0580
ACORD25(2001/08) Coll:1750664 Tn1:540539 Cart:7724702 0ACORDCORPORATIONIAM
Page 2 of 2
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25 (2001108) Coll:1750664 Tpl:540539 Cert:7724702