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HomeMy WebLinkAbout304997 BELFOR ENVIRONMENTAL INC - INSURANCE CERTIFICATECERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 04/01/2010 PRODUCER Aon 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 CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE Suite 3000 COVERAGE AFFORDED BY THE POLICIES BELOW. Southfield Mi 48075 USA INSURERS AFFORDING COVERAGE NAIC# PHONE- 866 283-7122 FAX- 847 953-5390 INSURED INSURER A: Pinnacol Assurance Company 41190 Belfor Environmental, Inc. 18058 r~ INSURERB: Philadelphia Indemnity Ins Co 5075 Kalamath Street INSURERC: Insurance Company of the State of PA Denver Co 80221 USA 19429 INSURER D: National union Fire ins Co of Pittsburgh 19445 INSURERE: Chartis Specialty Insurance Company 26883 e rnv>;.R Ar_>;.c SIR aDDlles Der terms ana Conoltions or the DOIICY 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 CERTLFICATE 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 INSR ADD' LTR INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS ATE MM/DD/Y DATE(MM/DD/YYYY D ERAL LIABHFrY GL4376513 04/01/2010 04/01/2011 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED $1, 000 , 000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE X❑ OCCUR - PREMISES (Ea occurrence) MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1 , 000, 000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2 , 000, 000 ❑ POLICY X❑ PRO- LOC El - JECT c AUTOMOBILE LIABILITY CA8263538 04/01/2010 04/01/2011 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $1, 000 , 000 BODILY INJURY X ALL OWNED AUTOS SCHEDULED AUTOS ( Per person) X HIRED AUTOS BODILY INJURY NON OWNED AUTOS (Per accident) X Comp Ded $1,000 PROPERTY DAMAGE X toll Ded $1.000 (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT AUTO OTHER THAN EA ACC HANY AUTO ONLY: AGG C EXCESS/UMBRELLA L1ABH.IrY 9613260 - 04/01/2010 04/01/2011 EACH OCCURRENCE - OCCUR ❑ CLAIMS MADE AGGREGATE $5,000,000 - ®DEDUCTIBLE RETENTION - $10,()00 D A WORKERS COMPENSATION AN EMPLOYERS' LIABILITY Y N WC0071862 5 ADS 4051232 04/01/2010 12/01/2009 U4/UI/ZUII 12/01/2010 X we STATu- IMITS OTH- R E.L. EACH ACCIDENT $1,000,000 ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under SPECIAL PROVISIONS below CO - E.L. DISEASE -EA EMPLOYEE $1, 000, 000 E.L. DISEASE -POLICY LIMIT $1, OOO , OOO E OTHER Pollutn/Env Imp CP016851546 04/01/2010 04 Ol 011 Aggregate $15,000,000 Per occurrence $15,000,000 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. CERTIFICATE HOLDER CANCELLATION City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Attn . James O'Neil II, CPPO, CPPB DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 215 North mason, Z nd Floor 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO TIME LEFT, P.O. BOX 5ma 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 25 (2009/01) ©1988-2009 ACORD CORPORATION. All rights The ACORD name and logo are registered marks of ACORD