HomeMy WebLinkAbout468473 VEOLIA ES TECHNICAL SOLUTIONS LLC - INSURANCE CERTIFICATE (3)CERTIFICATE OF LIABILITY INSURANCE M/DD/YYYY)
06/23/
ACORD 06/23/2010
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PRODUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION
Marsh USA Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
1000 Main Street, Suite 3000 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Houston, TX 77002 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Attn: Houston.Certs@marsh.com; 212-948-0509 1
010056-Veoli-Prima-10/11 HENDE
INSURED
VEOLIA ES TECHNICAL SOLUTIONS, LLC
9131 EAST 96TH AVENUE
HENDERSON. CO 80640
r-nvconr--Gc
INSURERS AFFORDING COVERAGE
INSURER A. New Hampshire Insurance Company
INSURER B: Insurance Company Of The State Of PA
INSURER c: National Union Fire Ins Co Pittsburgh PA
INSURER D: Commerce And Industry Ins Co
INSURER E: Illinois National Insurance Company
NAIC #
23841
19429
19445
19410
23817
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.
NSR
LTR
ADD'
INSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE(MM/DD/YYYY)
POLICY EXPIRATION
DATE (MM/DD/YYYY)
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
GL 4572700
07/01/2010
07/01/2011
EACH OCCURRENCE
1,000,000
DAMAGE
PRE. SESOEa o curreence
$ 1,000,000
MED EXP (Any one person)
$ 10,000
CLAIMS MADE FX I OCCUR
PERSONAL & ADV INJURY
$ 1,000,000
X C9-NTBACTUALLIABILITY-RR
GENERAL AGGREGATE
$ 1,000,000
GENERAL AGGREGATE LIMIT APPLIES PER
PRO -
POLICY X JECT LOC
PRODUCTS - COMP/OP AG
$ 1,000,000
B
B
AUTOMOBILE
X
LIABILITY
ANY AUTO
CA 4576281 All Other States
( )
CA 4576282 (MA)
07/01 /2010
07/01/2010
07/01 /2011
07/01/2011
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
BODILY INJURY
(Per person)
$
B
B
ALL OWNED AUTOS
SCHEDULED AUTOS
CA 4576283 (VA)
CA 0934628 (AIDS - PP)
07/01 /2010
07/01/2010
07/01 /2011
07/01/2011
BODILY INJURY
$
B
X
HIRED AUTOS
CA 0934629 (VA - PP)
07/01/2010
07/01/2011
B
X
NON -OWNED AUTOS
CA 0934634 (MA - PP)
07/01/2010
07/01/2011
IPer accident)
PROPERTY DAMAGE
(Per accident)
$ -
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANY AUTO
OTHER THAN EA ACC
AUTO ONLY:
AGG
$
$
EXCESS / UMBRELLA LIABILITY
EACH OCCURRENCE
$
OCCUR CLAIMS MADE
AGGREGATE
$
$
DEDUCTIBLE
$
RETENTION $
A
WORKERS COMPENSATION AND
IWC6517886(AOSinclWV)
07/01/2010
07/01/2011
X WCSTATU- OTH-
C
B
D
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N
OFFICER/MEMBER EXCLUDED? N
(Mandatory in NH) If yes, describe under
SPECIAL PROVISIONS below
IWC 6517888 (CA)
WC 1558356 (FL)
WC 6517889 (MA, WI & Stop Gap)
07/01/2010
07/01 /2010
07/01/2010
07/01/2011
07/01/2011
07/01/2011
.L. EACH ACCIDENT
$ 1,000,000
L. DISEASE- EA EMPLOYE
$ 1,000,000
.L. DISEASE - POLICY LIMIT
$ 1,000,000
OTHER
E
Workers Compensation and
WC 4883561 (TX)
07/01/2010
07/01/2011
See Above Limits
B
Employers Liability
WC 4883563 (OR)
07/01/2010
07/10/2011
DESCRIPTION OF OPERATIONSlLOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
CITY OF FORT COLLINS, ITS OFFICERS, AGENTS AND EMPLOYEES ARE INCLUDED AS AN ADDITIONAL INSURED (EXCEPT AS RESPECTS ALL
COVERAGE AFFORDED BY THE WORKERS' COMPENSATION POLICY) AS REQUIRED BY CONTRACT, BUT ONLY FOR LIABILITY ARISING OUT OF
THE OPERATIONS OF THE NAMED INSURED.
CERTIFICATE HOLDER HOU-001421305-04 CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
CITY OF FORT COLLINS
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
PURCHASING DIVISION
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
ATTN: ED BONNETTE, CPM
215 NORTH MASON
BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND
P.O. BOX 580
UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
FORT COLLINS, CO 80522
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc. or y
Barry N. Smith
ACORD 25 (2009/01) @ 1998-2009 ACORD CORPORATION. All Rights Reserved
The ACORD name and logo are registered marks of ACORD
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
This Certificate of Insurance 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.
MARSH USA INC.
1000 MAIN STREET, SUITE 3000
HOUSTON, TX 77002
ATTN: HOUSTON.CERTS@MARSH.COM; 212-948-
008075
CITY OF FORT COLLINS
PURCHASING DIVISION M-008075
ATTN: ED BONNETTE, CPM
215 N MASON ST
FORT COLLINS CO 80524-4402 770
015637