HomeMy WebLinkAbout330448 JACO ENVIRONMENTAL - INSURANCE CERTIFICATE (7)ACORD. CERTIFICATE OF LIABILITY INSURANCE Page 1 of 2 03/O3/2005
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 Blvd. 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 INSURERS: St. Paul Fire and Marine Insurance CcuWan 24767-001
Snohomish, WA 98291
INSURERC: Caumeres and Iadustry Insurance Company 19410-003
INSURERD:American International Specialty Lines In 26883-002
INSURERE:Illinois Union Insurance Company 27960-000
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE 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
DD'
SRDATE
TYPEOFINSURANCE
POLICY NUMBER
POLICYEFFECTIVE
(MMIDD/YYI
POLICYEXPIRATION
DATE (MMIDDIYYI
LIMITS
],
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
0453413
9/15/2004
9/15/2005
EACH OCCURRENCE _
S _2�OO 0,000
DAMAX
PREMISES PREMISES RENTED
$ 1,000,000
MED EXP (Anyone person)
$
CLAIMS MADE Fx_1 OCCUR
PERSONAL&ADV INJURY
$ 11000,000
GENERALAGGREGATE
$ 2,000,000
GENT AGGREGATE LIMIT APPLIES PER:
PRODUCTS-COMP/OP AGG
$ 2,000,000
POLICY PRO- LOC
CT
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Eaaccident)
$
BODILY INJURY
(Per person)
$
ALLOWNEDAUTOS
SCHEDULEDAUTOS
BODILY INJURY
(Pereccideot)
$
HIRED AUTOS
NON -OWNED AUTOS
PROPERTYDAMAGE
(Persccident)
$
GARAGE LIABILITY
AUTO ONLY -EA ACCIDENT
$
OTHERTHAN EAACC
$
ANYAUTO
$
AUTO ONLY: AGG
B
EXCESS LIABILITY
QK09400253
9/15/2004
9/15/2005
EACHOCCURRENCE
$ 1,000,000
AGGREGATE
$ 11000,000
X OCCUR CLAIMS MADE
$
$
DEDUCTIBLE
$
X RETENTION $ 10 00
*
WORKERS COMPENSATION AND
EMPLOYERS'LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
CA WC3287955
2/28/2005
2/28/2006
we sTATu• X OTL
E.L. EACH ACCIDENT
$ 1 1000,000
E.L. DISEASE - EA EMPLOYEE
$ 1 OOO OOO
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE -POLICY LIMIT
1 $ 1,000,000
D
OTHERP011ution 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 R&O
$1,000,000. per claim
15,000. retention
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSK)NS ADDED BY ENDORSEMENDSPECIAL PROVISIONS
I c nvlLunn
Collins
Division
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
Fort Collins, CO 80522-0580
i
ACORD 25 (2001/081
Co11:1231487 Tto1:349561 Cert:5505935
®ACORD CORPORATION 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
87 TD1:349561 Cert:5505935