HomeMy WebLinkAboutALLIED WASTE INDUSTRIES - INSURANCE CERTIFICATEG
ACORDm CERTIFICATE OF LIABILITY INSURANCE Page 1 of 3 12/28/2004
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. - 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 NAIC#
INSURED Allied Waste Industries, Inc. INSURERA: American Home Assurance Company 19380-OOd
(Named Inod. Con.t Belem)
Gr
15880 N. Greeaway-Hayden INSURERB:American Home Assurance Company 19380-005
Loop, Suite 100 1 INSURERC: Illinois National Ins. Co. 23817-002
Scottsdale, AZ 85260
INSURER D: National Union Fire IaB. Co. of Pitteburc 19445-001
1U V CKAU C,
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
LTR
ADDI
INSRE
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MID
POLICY EXPIRATION
DATE MMN
LIMITS
A
X
GENERALLIABILITY
GL6007644
l/l/2005
l/l/2006
EACHOCCURRENCE$
2,500,000
PREMISES E INT'E'D ce
$ 100 OOO
X COMMERCIAL GENERAL LIABILITY
MED EXP (Any one person)
$
CLAIMS MADE Fx7OCCUR
PERSONAL& ADV INJURY
$ 2,500,000
GENERALAGGREGATE
$ 10,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY % LOC
PRODUCTS-COMP/OPAGG
$ 51000,000
A
A
AUTOMOBILE
X
LIABILITY
ANYAUTO
CA2045015
CA2045016
l/l/2005
l/l/2005
l/l/2006
1/1/2006
COMBINED SINGLE LIMIT
(Ea accident)
$ 5,000,000
BODILY INJURY
(Per person)
$
$
C
ALL OWNED AUTOS
SCHEDULEDAUTOS
CA2045017
CA2045018
l/l/2005
1/1/2005
1/1/2006
1/1/2006
BODILY INJURY
(Peraccidem)
$
HIREDAUTOS
NON-OWNEDAUTOS
PROPERTYDAMAGE
(Per accident)
$
GAR AGE LIABILITY
AUTO ONLY -EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
D
EXCESSLIABILITY
X I OCCUR CLAIMS MADE
BE2860859
1/1/2005
1/1/2006
EACH OCCURRENCE
$ 51000,000
AGGREGATE
$ 5.000.000
DEDUCTIBLE
$
RETENTION $
E
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
WC5899177
1/1/2005
1/1/2006
Cg uI� 7
X TORY LAMITS OER
E.L. EACH ACCIDENT
$ 11000,000
C
A
A
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBEREXCLUDED?
If es, tlescdbe under
SPECIAL PROVISIONS below
WC5899176
WC5899174
W 17
1/1/2005
l/l/2005
1 2O
l/l/2006
1/1/2006
1 2
E.L. DISEASE -EA EMPLOYEE
$ 11000,000
E.L. DISEASE -POLICY LIMIT
$ 1,000,000
E
OTHER
WC5899179
1/1/2005
1/l/2006
A
Workers Compensation
WC5899178
l/l/2005
l/l/2006
$1,000,000 Each Accident
$1,000,000 Disease Policy Limit
91,000,000 LimitEach Employee
DESCRIPTION OFOPERATIONS/LOCATIONSNENICLESIEXCLUSK)NSADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Named Insured Includes: $PI Northern Colorado
City of Fort Collins
P 0 Box 580
Fort Collins, Co 80522
I
ACORD 25 (2001/08) Coll:1172666 TD1:326988
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
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
197616
01 Amen cneonoATlnfu 1000
I1115
CERTIFICATE OF LIABILITY INSURANCE page 2 of 3
DATE
12/28/2004
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 Cert 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
NAIC#
INSURED
Allied Waste Industries, Inc.
INSURERA: American Home Assurance Company
19380-004
INSUREAR American Home Assurance Company
19380-005
(Named Insd. Con.t Below)
15880 N. Greenway-Hayden
INSURERC: Illinois National Ins. Co.
23817-002
Loop, Suite 100
INSURERD: National Union Fire Ins. Co. of Pittsburg
19445-001
Scottsdale, AZ 85260
INSURERE: Ins. Co. of the State of PA
19429-004
NAMED INSURED INCLUDES - BFI WASTE SYSTEMS OF NORTH AMERICA, INC.
Employers Liability (Stop Gap) coverage for Monopolistic states is included:
Certificate Holder is Additional Insured, except for Workers Compensation, if required by written
contract.
Coll:1172666 Tpl:326988 Cert:5197616
Page 3 of 3
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(2001108) Coll:1172666 Tp1:326988 Cert:5197616