HomeMy WebLinkAbout330448 JACO ENVIRONMENTAL - INSURANCE CERTIFICATEACORDn, CERTIFICATE OF LIABILITY INSURANCE Page 1 of 2 02/28/2007
PRODUCER 877-945-7378 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
D
Willie North America, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEN OR
26 Century Blvd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P. O. Box 305191
Nashville, TN 372305191 INSURERSAFFORDINGCOVERAGE NAIC#
INSURED JACO Environmental, Inc.
PO Box 1478
Snohomish, WA 98291
COVERAGES
INSURERA: Lexington Insurance Cc
INSURERS: St. Paul Fire and Mari:
INSURERC: Commerce and Industry
INSURERD: American International
INSURER E:
Lines InI26883
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
ADD'L
TYPEOFINSURANCE
POLICY NUMBER
POUCYEFFECTIVE
POLICY EXPIRATION
LIMITS
A
GENERAL LIABILITY
7351449
9/15/2006
9/15/2007
FACHOCCURRENCE
$ 2,000,000
PREMISES Ee occurence
$ 11000,000
$ COMMERCIAL GENERAL LIABILITY
CLAIMS MADE ® OCCUR
MED EXP(Anyone person)
$
PERSONAL& ADV INJURY
$ 11000,000
K WA Stop Gap Included
g
$10,000 Deductible
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS-COMP/OP AGG
$ 2,000,000
POLICY PRO- LOC
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULEDAUTOS
BODILY INJURY
(Per amident)
$
HIRED AUTOS
NON-OWNEDAUTOS
PROPERTYDAMAGE
(Peraocident)
$
GAR AGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHERTHAN EAACC
$
ANYAUTO
$
AUTO ONLY: AGG
B
EXCESS LIABILITY
QK08400048
9/15/2006
9/15/2007
EACHOCCURRENCE
$ 4,000,000
$ OCCUR CLAIMS MADE
AGGREGATE
$ 4,000,000
$
DEDUCTIBLE
$
X RETENTION $ 10 0O
C
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
AOS WC3424398
2/28/2007
2/28/2008
g I wcBTATU- OTH-
Ea-
E.L. EACH ACCIDENT
$ 11000,000
C
ANY PROPRIETOR/PARTNEWEXECUTIVE
CA WC3424399
2/28/2007
2/28/2008
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
OFFICER IV EMBER EXCLUDED?
It yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE -POLICY LIMIT
$ 1,000,000
D
OTHER
1361078
9 15 200b
9 15 2007
Pollution Legal Liability
$1,000,000 Per Incident
including BI/PD & Cleanup
$2,000,000 Aggregate
25 00 Deductible, Each Incident
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
The Workers' Compensation ADS policy covers Oregon, Nevada, and Utah 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, SUIT 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 REPRESENT ES.
Attn: Christine Patterson -Jarvis
700 Wood Street AUTHORI REPRESENTATN�
Fort Collins, CO 80522-0580
ACORD 25 (2001=) Coll:1905635 Tpl:602788 Cert:8614632 ®ACORDCORPORATION 1988
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 (2001/00) C011:1905635 TD1:602788 Cert:8614632