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HomeMy WebLinkAbout304997 BELFOR ENVIRONMENTAL - INSURANCE CERTIFICATEACORDT. CERTIFICATE OF LIABILITY INSURANCE °ATE12/03/22008Y� PRODUCER Risk Services Central, Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY Southfield MI Office AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 3000 Town Center Suite 3000 Southfield MI 48075 USA CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# PHONE- 866 283-7122 FAX- 847 953-5390 INSURED INSURER A: Insurance Company of the State of PA 19429 Belfor Environmental, Inc. 5075 Kalamath Street INSURERB: National union Fire Ins Co of Pittsburgh 19445 INSURER C. American International Specialty Lines 26883 Denver CO 80221 USA INSURER 1) Pinnacol Assurance Company 41190 INSURER E. COVERAGES SIR applies per terms and conditions of t e THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A13OVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, PERM OR CONDITION OF ANY CONTRACT OR 9111ER DOCUMENT WITH RESPECT TO WHICH TI BS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, DIE 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. LIMITS SHOWN ARE AS REQUESTED INSIt L'TR AUDI INSRI TYPE OFINSURANCE POLICY NUMBER POLICY EFFEC'TIVF. DA'IR(MM\DD\VY) POLICE' EXPIRATION DATE(MM\DD\)'Y) LIMITS B "ERALLIABILITY GLI617663 04/01/08 04/01/09 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $1,000,000 CLAIMS MARL © OCCUR m NMISF,S (Ea oeonrooee) M13D L'P (AnV One nersonl 1 PERSONAL R ADV INJURY $1,000,000 GENERAL AGGREGATE, $2,000,000 GENT, AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG $2,000,000 ❑ POLICY El PRO- ❑ X t.oc Jc(rr B AD X 01MODILF. LIABLE]TY ANY AN 10 8262996 ADS 04/01/08 04/01/09 COMBINED SINGLE LIMIT (En reeidem) $1,000,000 ALL OWNED AUTOS BODILY INJURY SCIIEDULED AUTOS (Por Person) X HIREDAINOS BODILY INJURY X NON OWNED AUTOS (Per accident) Comp Ded $1,000 X PROPERTY DAMAGE (Parwoideel) X colt Ded $1,000 GARAGE LIABILITY AUTO ONLY - EA ACCIDENT 8 ANY nu'ro O'TtILR TITAN LA ACC AUl'o ONLY AGO A EXCESS/UMBRELLA LIABILITY BE7251549 64/01/08 04 O1 9 LACH OCCUMENCE$S10001000 MOCCUR ❑ CLAIMS MADE AGGREGATE $5,000,000 HDEDUCHBLE .. RE'IEN'I']ON D \YOIiKF:R$ COMPENSATION AND EMPLOYP.RS' LIABILITI, ANY PROPRIr TOR / PARTNER / PXF.CUI I VE 4051232 12 Ol X w(' sl'n'rU- " 0'nl- E. L. FACII ACCIDENT —. $1,000, 000 C I. DISEASE -EA EMPLOYEE $1,000 000 E OIIJCER/MLMIIHR EXCLUDED' If,o, do,edbe deSPECIAL PROVISIONS below GL. DISEASE POLICY LIMIT $1,000,000 r C OTHER CPL3779857 04/Ol/OS Per claim limit $15,000,000 POI lutn/Env Imp SIR/Deductible $100,000 DESCRIPTION 01: OPLRATIONS/LOCATIONS/VLHI(:1,ES/EXCLUSIONS ADDED ITY ENDOltSFMRN4/8PGCIAI. PROVISIONS Re: Fort Collins ER Contract The City of Fort Collins is included as Additional subrogation applies as required by contract. Insured with respects to General Liability. waiver of CERTIFICATE HOLDER 1CANCELLATION City Of Fort Collins Attn. lames O'Neil II, CPPO,CPPB 215 North Mason, 2nd Floor P.O. BOX 580 FOrt Collins CO 80522 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES RE CANCBLI.ED BEFORE'ILE EXPIRATION - DALE THERI,OP,"TIIEISSIIINGINSURF:RWB.LENDEAVORTOMAIL 30 DAYS WRITTEN NO'TICE "I'D THECER'I'I19CA'I E HOLDER NAMED'1'0 "1'HE LEFT, llUT1'All,UIt1'.'I'ODOSOSI1AId.IMPOSCNOOBLIGA'I'IONORLIAI3ILITY - OF ANY KIND 11PON TILE INSURBIt.ITS AGL'N'1'S OR IZEPI2ESIiNTA'TIVES. AUT110121LLD ItEPItESENTA'p WE A. D 25 2 1 ACQRD CORPORATIO 1 G DATE(MM/DD/YYYY) ACORDr,. ,CERTIFICATE OF LLABILITX INSURANCE, 04/01/20o8 PRODUCER Aon Risk Services Central, Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY fka Aon Risk Services, Inc. of Michigan 3000 Town Center Suite 3000 Southfield MI 48075 USA AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTERTHE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# PHONE- 866 283-7122 FAx- 847 953-5390 INSURED Belfor Environmental, Inc. 469 4690 7oliet street INSURER A: Pinnacol Assurance company 41190 WSURERB. Insurance Company of the State of PA 19429 Denver co 80239 USA INSURER American Home ASsurance.co. 19380 INSURER National Union Fire Insurance Co of VT 0162AL INSURER r: American International Specialty Lines 26883 COVERAGES SZR Ma A THE POLICIES OF INSURANCE LISPED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OL TER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS 011 SUCH POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR U,R ADD" INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DA'TE(MM)DD\YY) POLICY EXPlItAT10N DATE(MM\DD\YY) LIMITS D GENERAL LIAHILI,TY X COMMERCIAL GENERAL LIABILITY GL1617663 04/01/08 04/01/09 EACH OCCURRENCE $1,000,000 DAMAGE I'O RENTED $1,000,000 CLAIMS MADii © OCCUR PREMISES (Ea Dccurcncc) MED G P (Anv one uMs.7 PERSONAL Pc ADV INJURY $1,000,000 ❑ GENERAL AGGREGA'IL $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PLR. PRODUCTS - COMP/OP AGG $2,000,000 El POLICY © 1EC1' LOC c AUTOMOBILE X LIABILITY ANY AUTO cA8262996 Auto Liability AOS 04/01/08 04/01/09 COMBINED SINGLE LIMIT (Bn necidenu $1,000,000 ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY ( Per persen) X HIRED AUTOS NON OWNED AUTOS BODILY INJURY (Per eceiden0 X Comp Ded $1,000 X PROPER'LYDAMAGE (Peracciden0 X Coll Ded $1.000 GARAGE LIABILITY AUTO ONLY - EA ACCIDENT ANY AUTO 8 OTI{GR'1'WAN EA ACC AUTO ONLY: AGO B EXCESS/UMBRELLA LIABILITY BE7251549 04/01/08 04/01/09 EACH OCCURRENCE OCCUR 1-1 CLAIMSMADE AGGREGATE $5,000,000 DEDUCTIBLE RETENTION A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 4 51 1 1 7 X FI SI AID- I\ IT. UT G.L. EACH ACCIDENT' $500,000 0 ANY PROPRIETOR / PAIt'I'NEIt /EXECUTIVE OFFRTR/MEMBER EXCLUDED' F.L. DISEASE -EA EMPLOYEE $500,000 Ifycs, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $500,000 M � E Ot'L1ER Pollutn/Env Imp CPL3779857 04/01/08 4 1 Per C1 dim Limit $15,000,000 SIR/Deductible $100,000 DESCRIPTION OF OPERA 'I'IONS/LOCATIONS/VLl11CIAS/EXCLUSIONS ADDED B1' I:ND012SGMEN'I/SPECIAL PROVISIONS S Re: Fort Collins ER Contract The City of Fort Collins is included as Additional Subrogation applies as required by contract. 5 insured with respects to General Liability. waiver of CERTIFICATE HOLDER CANCELLATION City Of Fort Collins Attn. )Imes ON - �ll II, CPPO,CPPB 215 North Mason, 2nd Floor SHOULD ANY OF'I HE ABOVE DESCRIBED POLICIES BE CANCELLEDBEPORE THE EXPIRATION DATE'IALREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL. M 30 DAYS WRI'11ENNUTCETO THE: CERTIFICATE HOLDER NAMED 70111E LEFT', P.O. BOX 580 Fort Collins CO 80522 USA BUT FAILURGTODO SO SIIALL IMPOSE NO OBLIGATION OR LIABILITY r OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. -' AUTHORIZED REPRESENTATIVE 'CORD CORPORATIONi198 1 t,,