HomeMy WebLinkAbout330448 JACO ENVIRONMENTAL - INSURANCE CERTIFICATE (3)ACOR-. CERTIFICATE OF LIABILITY INSURANCE Page 1 of 2 03/0DATE
6/2008
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 HOLDER THIS CERTIFICATE DOES NOT AMEND EXTEND OR
26 Century Blvd ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
P O Box 305191
Nashville IN 372305191 INSURERS AFFORDING COVERAGE NAIC#
INSURED JACO Environmental Inc INSURERA Lexington Insurance Cc 19437 000
PO Box 1478
Snohomish WA 98291 INSURERS St Paul Fire and Marine Insurance Compan 29767 001
INSURERC American Home Assurance Com any 19380 003
INSURERD American International Specialty Linea In 26B83 002
nnuvnwr«.
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
D
TypE OFINSURANCE
POLICY NUMBER
POLICYEFFECTIVE
F; LICYEXRRATION
LIMITS
A
GENERAL
LIABILITY
7355318
9/15/2007
9/15/2008
ENCE
$ 2
000
X
COMMERCIAL GENERAL LIABILITY
�OCCUR
DAMAGEcocuren e
$ 1
000
OOQ QQQCLAIMSMADE
nepewrn)
$X
WA Stop Gam Included
DV INJURY
=a$
$ l
QQQ QQQX
$10,000 Deductible
REGATE
$ 2
QQQ QQQGEN
L AGGREGATE LIMIT APPLI ES PER
X POLICY 7 PRO LOC
OMP/OPAGG
S 2
nnn OOO
AUTOMOBILE
LIABILITY
ANYAUTO
COMBINED SINGLE LIMIT
(Ea accident)$
ALL OWNED AUTOS
SCHEDULEDAUTOS
INJURY
Per der
erson)
$
HIRED AUTOS
NON OWNED AUTOS
BODILY accident)
(Per ea;WenO
$
PROPERTY DAMAGE
(Peracocen0
$
GAMGE LIABILITY
AUTOONLY EAACCIDENT
$
ANY AUTO
OAN EA ACC
$
$
AUTOUTO ONLY AGO
B
EXCESS/UMBRELLA LIABILITY
X OCCUR CLAIMS MADE
QK08400067
9/15/2007
9/15/2008
EACH OCCURRENCE
$ Tj
QQQ QQQ
AGGREGATE
$ 51000,000
DEDUCTIBLE
S
X RETENTION $ 10,00
$
C WORKERS COMPENSATION AND AOS WC3427183 2 2
EMPLOYERS LIABILITY / 8/2QQ8 2/28/2QQ9
WCSTATU OTH
X
C ANY PROPRIETORIPARTNEWEXECUTIVE CA WC3427184 2/28/2008 2/28/2009
OFFICER/MEMBER EXCLUDED'
EL EACH ACCIDENT $ 1
QQQ 000
It yes describe under
EL DISEASE EA EMPLOYEE $ 1
QQQ QQQ
SPECIAL PROVISIONS below
D OTHER 1361078 9 15 2007 9 15 2008
Pollution Legal Liability
including BI/PD & Cleanup
EL DISEASE POLICY LIMIT $ 1
$1 000 000 Per Incident
$2 000 000 Aggregate
QQQ QQQ
DESCRIPTION OF OPEMT0NS20CAnONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
The Workers Compensation AIDS policy Covers Oregon Nevada and Utah
125,000 Deductible Each Incident
only
reeTlorw,•v ur. non
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
D 25(2001/08) Coll 228:
747089 Cart 10386946 CACOROCORPORATInIN loan
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(2001/08) Coll 2282926 Tpl 747089 Cert 10386946