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HomeMy WebLinkAbout330448 JACO ENVIRONMENTAL - INSURANCE CERTIFICATE (10)ACOR ,. CERTIFICATE OF LIABILITY INSURANCE Page 1 of 27 08/13/2004 PRODUCER 877-945-7378 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Willis North America, Inc. - Regional cart Center HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 26 Century Blvd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. O. Box 305191 Nashville, TN 372305191 INSURERS AFFORDING COVERAGE INSURED JACO Environmental, Inc. PO Box 1478 Snohomish, WA 98291 ,:V V tMAlatj national Specialty Lines In 26883-002 and marine Insurance Compan 24767-001 tion Insurance Fund of Cali 35076-001 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 TYPEOFINSURANCE POLICYNUMBER POLICYEFFECTIVE 9/15/2003 POLICY EXPIRATION LIMITS A GENERAL LIABILITY EG1955643 9/15/2004 EACHOCCURRENCE _ $ 2�O00 000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE FOOCCUR FIRE DAMAGE (Any we fire) $ 300.000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- SIRLOC PRODUCTS-COMP/OP AGG $ 2,000,000 AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ HIRED AUTOS NON -OWNED AUTOS BODILY amident) (Per accident) $ PROPERTYDAMAGE (Peraaident) $ GARAGE LIABILITY AUTO ONLY -EAACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG B EXCESS LIABILITY X OCCUR CLAIMSMADE SP090503 9/5/2003 9/15/2004 EACHOCCURRENCE $ 11000,000 AGGREGATE $ 11000,000 DEDUCTIBLE $ RETENTION $ L+ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 1507824 2/28/2004 2/28/2005 WC STATU- X OTH- E.L. EACH ACCIDENT $ 11000,000 E.L. DISEASE -EA EMPLOYEE $ 11000,000 E.L. DISEASE -POLICY LIMIT $ 1000QQQ A OTHER CP0838318840 8/15/2004 8/15/2005 Pollution Liability Project Specific $3,000,000. per Claim/aggregate $ 25,000. retention DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES(EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS n en: City of Fort Collins Purchasing Division Attn: Christine Patterson -Jarvis 700 Wood Street Fort Collins, CO 80522-0580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSIF.J\O OBLIGATION 01—UIBILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR D25-S(7/97) Co11:1067465 Tpl:292170 Cert:4671 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-S (7/97) Co11:1067465 To1:292170 Cwrted6716n4 AL J.4C0 Environmental, Ine. Letter of Transmittal TO: Name: Christine Patterson -Jarvis City of Ft Collins, Purchasing Division Company: City of Fort Collins 700 Wood Street Fort Collins, CO 80522-0580 Urgent: For Review: MESSAGE: Christine: P. O. Box 1478 Snohomish, WA. 98291-1478 FROM: Michael H. Jacobsen Phone: 425-265-2210 FAX: 425-356-3921 E-mail: jaco_controller@yahoo.com Date: August 19, 2004 Number of pages including cover: 3 Here are the copies of the Insurance Certificates. The originals are being sent to your attention. The bond is being processed and will be forth coming. Please contact me if you have any questions. Michaf ' ACORD. CERTIFICATE OF LIABILITY INSURANCE page 1 of 2 DATE 08/19/2004 PRODUCER 877-945-7378 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Willis North America, xnc. - Regional Cart Center 26 Century Blvd. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. O. Box 305191 Nashville, TN 372305191 INSURERS AFFORDING COVERAGE INSURED SACO Environmental, Inc. INSURERA: American International Specialty Lines In 26883-002 INSURERS: St. Paul Fire and Marine Insurance Compan 24767-001 PO Box 1478 Snohomish, WA 98291 INSURERC: State Compensation Insurance Fund of Cali 35076-001 INSURERD: Illinois Union Insurance Company 27960-000 INSURER E: rnucoer_CQ 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 POLICY NUMBER POLICYTYPEOFINSURANCE DATEI MIDD/ YI POLICY EXPIRATION ITS LIMITS A GENERAL LIABILITY EG1955643 9/15/2003 9/15/2004 EACH OCCURRENCE $ 2,000,000 FIRE DAMAGE (Anyone fire) $ 300,000 X COMMERCIAL GENERAL LIABILITY MED EXP (Any one Person) $ 10,000 CLAIMS MADE OOCCUR PERSONAL S ADV INJURY $ 2.000.000 GENERALAGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PR7 LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ALLOWNEDAUTOS SCHEDULEDAUTOS BODILY INJURY (Peraccident) $ HIREDAUTOS NON-OWNEDAUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY -EA ACCIDENT $ OTHERTHAN EAACC $ ANYAUTO $ AUTO ONLY: AGG B EXCESS LIABILITY SP090503 9/5/2003 9/15/2004 EACHOCCURRENCE $ 1,000,000 AGGREGATE $ 11000,000 X OCCUR CLAIMS MADE $ DEDUCTIBLE $ RETENTION $ L. WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 1507824 2/28/2004 2/28/2005 TORY LIMITS X OER E.L. EACH ACCIDENT Is 1,000,000 E.L. DISEASE -EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $ 1,000,000 A OTHERPollution Liability CP0838318840 8/15/2004 8/15/2005 $3,000,000. per claim/aggregate D Project Specific BMXOS152005 8/15/2004 8/15/2005 $ 23,000. retention Professional E&O $1,000,000. per claim IS 15,000, retention DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS THIS VOIDS AND REPLACES PREVIOUSLY ISSUED CERTIFICATE DATED: 8/13/2004 WITH ID: 4671605 CFRTIFICATF F101 nFR I I ennnnnuw Iueuean. imm inFR I.FT R- CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL City 0£ Fort Collin IMPOS O OBLIGATION L BILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Purchasing Division Attn: Christine Patterson -Jarvis BE ATEB. N A HOR REP SE VE 700 Wood Street Fort Collins, CO 80522-0580 ACORD 25-S (7/97) Coll:1071425 TVI:292170 Cert:467767@ j ©ACORDCORPORATION 1988 Policy Number: 601420332 Date Entered: 8/13/2004 ACORDCERTIFICATE OF LIABILITY INSURANCE DATE o PRODUCER Dxstrmct U3 ConneraialCenter 16300 Mill Creek Blvd #203 Mill Creek, WA 98012 (425)745-9780 Agent -Rob THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIL # INSURED ^-�A n �Nv 1 RpN(y)oA -� I�.�C.. J Rl� DBA: Appliance Recycling outlet 10105 Airport Way Snohomish, WA 98291 Fa�xoers Truck Insurance Group INSURER A: INSURER B:General Star Indemnity Company INSURER C: INSURERD: 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 ADUL TYPE OF INSURANCE POLICY NUMBER POLICYEFFECTIVE DATE (MWDD") POUCYEXMRATIONLTR DATE IMMIDONY1 LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE 70 RENTED PREMISES(—Eao�rerke) $ MED EXP (Any one pereon) $ CLAIMS MADE D OCCUR PERSONAL S ADV INJURY $ GENERAL AGGREGATE $ GETL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO- LOC A X AUTOMOBILE LIABILITY ANY AUTO 601420332 9/15/2003 9/15/2004 COMBINED SINGLE LIMIT (Ea *=bw ) $ 2 , 000 , 000 BODILY INJURY (Per parson) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Peraccidenq $ HIRED AUTOS NON -OWNED AUTOS PROPERTYDAMAGE (Per sockbnl) $ GARAGE LIABILITY AUTO ONLY -EA ACCIDENT $ DER THAN EAACC $ ANYAFTO $ AUTOONLIC AGG EXCESBIUMBRELLA LIABILITY 1XG385509A 9 15 2003 9 15 2004 EACH OCCURRENCE $ B OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ WORMERS COMPENSATION AND EMPLOYERW LIABILITY STATUS LIMITS OTH- TOTY ANY PftOPPoETOR/PARTNERA7(ECUTNE EL. EACH ACCIDENT $ E.L. DISEASE- EA EMPLOYEE $ O-FICERANEMBER EXCLUDED? B yes 'A'T4 a urger E.L. DISEASE -POLICY LIMB $ SPECIAL PROVISIONS beioN OTHER DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Jaco Env. Carries $100 Comp.and $1000 Collision Deductible on all vehicles. City of Fort Collins Purchasing Division 700 Wood St. Fort Collins, CO 80522-0580 ACORD 26 SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO BAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR Robert P. Byrd :aia] : I Ia7 : L• r1 l IMP i k F: I:7