HomeMy WebLinkAbout330448 JACO ENVIRONMENTAL - INSURANCE CERTIFICATE (8)ACORD,CERTIFICATE OF LIABILITY
DATE
1
� INSURANCE page
1 of 2
03/06/2006
PRODUCER 877-945-7378
THIS CERTIFICATE IS ISSUED A
ONLY AND CONFERS NO RIG TS
A MATTER OF INFORMATION
UPON THE CERTIFICATE
Willis North America, Inc. - Regional Cert center
26 Century Blvd.
HOLDER. THIS CERTIFICATE DO
ALTER THE COVERAGE AFFORD
S NOT AMEND, EXTEND OR
D BY THE POLICIES BELOW.
P. 0. Box 305191
Nashville, TN 372305191
INSURERS AFFORDING COVERAGE
NAIC#
INSURED JACO Enviro—ental, Inc.
INSURER A: Lexia ton Insurance Co.
19437-000
PO Box 1478
Snohomish, WA 98291
INSURERS: St. Paul Fire and Karin
Insurance Compan
24767-001
INSURERC: Commerce and Industry I surance
Company
19410-003
INSURERD: American International *!!cialty
Lines InI
26883-002
INSURERE: Illinois Union Insuranc
C an
27960-001
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY FIE RllD
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, EXCL
SONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADWI
TYPEOFINSURANCE
POLICYNUMBER
POLICY EFFECTIVE
DATE (MMODI'M
POLICY EXPIRATIONJJ3L
DATE (1011100"
LIMITS
A
GENERAL LIABILITY
4135318
9/15/2005
9/15/2006
EACHOCC
RRENCE
$ 2,000,000
X COMMERCIAL GENERAL LIABILITY
CLAIMSMADE ® OCCUR
PREMISES
EeoccuD
$ 1,000,000
MED FXP (Any
one person)
$
PERSONA
&ADVINJURY
$ 11000,000
X WA Stop Gap 8L flail
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCT
-COMP/OPAGG
$ 2,000,000
POLICY PRO-JECT LOC
AUTOMOBILE
LIABILITY
ANYAUTO
COMBINED
(Ea aceWent
INGLE LIMIT
$
BODILY INJI
(Per person)
RV
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJ
(Per acolden
RV
$
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY
(Per axident
AMAGE
$
GARAGE LIABILITY
AUTO ONLY
EA ACCIDENT
$
OTHERTHANLY:
EAACC
$
ANY AUTO
$
AUTO O
AGG
H
EXCESS LIABILITY
9KOB400031
9/15/2005
9/15/2006
EACHOCCu
RENCE
$ 4,000,000
X OCCUR F1 CLAIMS MADE
AGGREGAT
$ 4 00Q 0Q0
$
$
RDEDUCTIBLE
$
X RETENTION $ 10 O0
C
C
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
AIDS NC3421557
CA WC3421558
2/28/2006
2/28/2006
2/28/2007
2/28/2007
X ORYI WCST
Tu- oTH FA
E.L.EACH A
IDENT
$ 11000.0 0
E.L. DISEASE
- EA EMPLOYEE
$ 11000,000
OFFICER/MEMBER EXCLUDED?
It yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE
POLICY LIMIT
$ 1,000,000
D
OTNERPollution Liability
CP01354402
8 15 2005
8 15 20 66
$3,000,0
0. per claim/aggregate
E
Project Specific
BM120024662
8/15/2005
8/15/2006
$ 25,0
0. retention
Professional E&O
$1,000,0
0, per claim
15.0
0. retention
DESCRIPTION OF OPERATIONWLOCATONSNENICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Workers, Compensation AOS policy includes Utah and Oregon only.
CERTIFICATE HOLDER CANCELLATION '.i01apIrIA�r1O!5N �-I:,dA
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES B
CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL END
OR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO TH
LEFT, BUT FAILURE TO DO SO SHALL
City of Fort Collins
Purchasing Division
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIN
UPON THE INSURER, ITS AGENTS OR
Attn: Christine Patterson -Jarvis
REPRESENT ES.
AUTHO REPRESENTA
700 Wood Street
Fort Collins, CO 80522-0580
AGORD25(2001108) Coll:1560563 Tpl:472383 Cert:6999117 7 ACORD CORPORATION 1988
PageJ2 of 2
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorse. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement( ).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certaipolicies 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 co tract between
the issuing insurer(s), authorised representative or producer, and the certificate holds , nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
25(2001/08) C011:1560563 Tp1:472383 Cert:699