HomeMy WebLinkAbout330448 JACO ENVIRONMENTAL - INSURANCE CERTIFICATE (9)ACORDTM CERTIFICATE OF LIABILITY INSURANCE Page 1 of 2 03/01/2005
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 Elva. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P. O. Box 305191
Nashville, TN 372305191 INSURERS AFFORDING COVERAGE NAIC#
INSURED JACO Environmental, Inc. INSURERA: Lexington Insurance co. 19437-000
PO Box 1478 INSURERB: St. Paul Fire and Kerins Insurance Compan 24767-001
Snohomish, WA 98291
INSURERC: Comearce and Industry Insurance Company 19410-003
INSURER D: American International Specialty Lines In 26883-002
INSURERE:Illinois Union Insurance Company 27960-000
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
41301
rypE OFINSURANCE
POUCYNUMBER
POLICYEFFECTIVE
POLICYEXPIRATION
LIMITS
A
GENERALLIABILITY
0453413
9/15/2004
9/15/2005
EACH OCCURRENCE _
$ 2�000, OOO
PREMIAMATo RENTED
PREMISES E occurence)
$ 1,000,000
X COMMERCIAL GENERAL LIABILITY
MED EXP (Anyone person)
$
CLAIMS MADE 1_X I OCCUR
PERSONAL S ADV INJURY
$ 1,000,000
GENERALAGGREGATE
$ 2,000,000
GENT AGGREGATE LIMIT APPLIES PER:
PRODUCTS-COMP/OP AGG
$ 2,000,000
POLICY PRO Loc
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Eaaccident)
$
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULEDAUTOS
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
PROPERTYDAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY• EA ACCIDENT
$
OTHERTHAN EAACC
$
ANY AUTO
$
AUTO ONLY: AGG
B
EXCESS LIABILITY
QK09400253
9/15/2004
9/15/2005
EACHOCCURRENCE
$ 1,000,000
X OCCUR CLAIMS MADE
AGGREGATE
$ 1.000.000
$
RDEDUCTIBLE
$
RETENTION $ 10,00
*
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
Cps WC3287955
2/28/2005
2/28/2006
OTH-
WCSTATU• % EEL
E.L. EACH ACCIDENT
$ 11000,000
E.L. DISEASE• EA EMPLOYEE
$ 1,000,000
OFFICERIMEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE• POLICY LIMIT
$ 1,000,000
D
OTHERPollution Liability
CP0838318840
8/15/2004
8/15/2005
$3,000,000. per claim/aggregate
E
Project Specific
BMI08152005
8/15/2004
8/15/2005
$ 25,000. retention
Professional E&O
$1,000,000. per claim
15,000. retention
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CFRTIFICATF HOLDER 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 of Fort Collins
Purchasing Division
Attn: Christine Patterson -Jarvis
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENT ES.
AUTHOR REPRESENTA' r�
700 Wood Street
Fort Collins, CO 80522-0580
AGORD25(2001108) Coll:1231487 Tpl:349561 Cert:5505935 VACOROCORPORATION 198B
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.
ACORD25(2001/08) Co11:1231487 TV1:349561 Cert:5505935