HomeMy WebLinkAbout330448 JACO ENVIRONMENTAL - INSURANCE CERTIFICATE (11)ACORD,. CERTIFICATE OF LIABILITY INSURANCEPage 1 of 2 1 U8/lATE
'RODUCER A77-965-737A THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Willis North America, Inc.
26 Century Blvd.
P. 0. Box 305191
Nashville, TN 372305191
NSURED JACO Environmental, Inc.
PO Box 1478
Snohomish, WA 98291
.T.�T)I�=r•�sxa
ONLY AND CI
HOLDER. THIS
INSURERS AFFORDING COVERAGE
INSURER A: Lexington Insurance Co.
INSURERS: St. Paul Fire and Marine
INSURERC: Commerce and Industry In
INSURER D: American International S
INSURERE: Illinois Union Insurance
OR
NAIC#
e Compare 24767-001
oapany 19410-003
Lines In 26883-002
27960-001
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.
VSR
ADD'L
um
TYPE OFINSURANCE
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATIONJil-
DATE (MM(DIYYYI
LIMITS
A
GENERAL LIABILITY
4135318
9/15/2005
9/15/2006
EACH OCCURRENCE
$ 2,000,000
PREMISES Eacccurance
$ 1,000,000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR
MED EXP(Any one person)
$
PERSONAL&ADV INJURY
$ 11000,000
X WA Stop Gap EL $lmil
GENERAL AGGREGATE
$ 2.000.000
GENL AGGREGATE LIMIT APPLIES PER:
PRODUCTS-COMP/OP AGG
$ 2,000,000
1-1 POLICY PRO LOG
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY
(Perperson)
$
ALL OW NED AUTOS
SCHEDULEDAUTOS
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
PROPERTYDAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHERTHAN EAACC
$
ANY AUTO
$
AUTOONLY: AGG
EXCESS LIABILITY
QK08400031
9/15/2005
9/15/2006
EACHOCCURRENCE
$ 4,000,000
::Xl OCCUR 1:1CLAIMS MADE
AGGREGATE
$ 4 00O 000
$
DEDUCTIBLE
$
X RETENTION $ 10 00
WORKERS COMPENSATION AND
EMPLOYERS'LIABILITY
AIDS WC3421557
2/28/2006
2/28/2007
X WC STATU- OTH-
E.L. EACH ACCIDENT
$ 1,000,000
'
ANY PROPRIETOR/PARTNER/EXECUTIVE
CA WC3421558
2/28/2006
2/28/2007
E.L. DISEASE- EA EMPLOYEE
$ 1,000,000
OFFICER/MEMBER EXCLUDED?
It yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE -POLICY LIMIT
1 $ 1,000,000
1
OTHERPollution Liability
CP01354402
8/15/2005
9/15/2006
$3,000,000. per claimlaggregate
Project Specific
BMI20024662
8/15/2005
9/15/2006
$ 25,000. retention
Professional R&D
$1,000,000. per claim
15 000. retention
ESCRIFTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
orkers' Compensation AOS policy includes Utah and Oregon only.
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
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
CORD 25 (2001/08) Coll:1715052 Tpl:472383 Cert:7
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.
CORD25(2001/08) C011:1715052 Tp1:472383 Cert:76