HomeMy WebLinkAbout304997 BELFOR ENVIRONMENTAL - INSURANCE CERTIFICATE (2)DATE(M� D� YYYY)
ACORDrM , CE�I� 31 I'E 03 27 2009
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PRODUCER AOn tusk Services Central, Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
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Southfield MI Office AND CONFERS,NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
3000 . Town Center CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
Suite 3000 COVERAGE AFFORDED BY THE POLICIES BELOW.
Southfield MI 48075 USA
PHONE- 866 283-7122 FAX- 847 95375390 INSURERS AFFORDING COVERAGE NAIC #
INSURED
INSURER A: Pinnacol Assurance Company - -
41190
Belfor Environmental, Inc.
INSURERB: Philadelphia Indemnity. Ins Co
18058
5075 Kalamath Street
Denver Co 80221 USA
INSURERC: Insurance Company of the State of PA
19429
INSURERD: National union Fire Ins Co of Pittsburgh
19445
a
INSURERS American International Specialty Lines
26883
a
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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. LIMITS SHOWN ARE AS REQUESTED
R
LTR
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ADD'
INSRD
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION
LIMITS
DATE(MM\DD\YY)
DATE(MM\DD\YY)
D
ENERALLIABILITY
GL0919561
04/01/09
04/01/10
EACH OCCURRENCE'
$1,000,000
X COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
$1, 000, 000
CLAIMS MADE - X❑ OCCUR
PREMISES (Ea oceurence)
MED EXP (Any one person)
1 , 000
O
PERSONAL & ADV INJURY
$1, OOO, OOO
-
❑
-
�
GENERAL AGGREGATE
-
$2 , 000, 000
'" I
GEN'L AGGREGATE LIMIT APPLIES PER:
M
PRODUCTS - COMP/OP AGG
$2 , 000 , 000
X LOC
ElPOLICY ❑ PRO- ❑
M
O
JECT
r,
D
AUTOMOBILE LIABILITY
8263257
04/01/09
04/01/10
COMBINED SINGLE LIMIT
-
X ANY AUTO
(Ea accident)
$1, 000, 000
,2
X ALL OWNED AUTOS
a.
BODILY INJURY
SCHEDULED AUTOS
Per person)
!:
J:
X HIRED AUTOS
6
a
-
'
-
-BODILY INJURY
NON OWNED AUTOS
(Per accident)
NXX Comp Ded $1,000
PROPERTY DAMAGE
Coll Ded $1.000
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
H ANY AUTO
OTHER THAN EA ACC
AUTO ONLY:
AGG
C
EXCESS [UMBRELLA LIABILITY
BE23649334
04/01/09
04 O1 10
EACH OCCURRENCE
$5,000,000
aOCCUR ❑ CLAIMS MADE
AGGREGATE
$5,000,000
eDEDUCTIBLE
RETENTION
-
-
-
A
WORKERS COMPENSATION AND
4051 _
1 1 08
X
WC S
OTH-
EMPLOYERS' LIABILITY
T RY LIMIT
ER
-_
E.L. EACH ACCIDENT
-$1, 000, 000
_
ANY PROPRIETOR / PARTNER / EXECUTIVE
OFFICER/MEMBER EXCLUDED?
E.L. DISEASE -EA EMPLOYEE
$1, 000 , 000
If yes, describe under SPECIAL PROVISIONS
E.L. DISEASE -POLICY LIMIT
$1, 000, 000
below
E OTHER CP016851546 04/01/09 4 Aggregate Limit $15,000,000
Pollutn/Env imp Deductible $100,000
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Re: Fort Collins ER Contract
The City of Fort Collins is included as Additional Insured with respects to General Liability. waiver of
Subrogation applies as required by contract.
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SHOULD
City of Fort Collins
Attn . James O'Neil II, CPPO, CPPI3
ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
215 North mason, 2nd Floor
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
P.O. BOX 5 SO
BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
Fort Collins CO 80522 USA
AUTHORIZED REPRESENTATIVE
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