HomeMy WebLinkAbout132133 WASTE-NOT RECYCLING (EARTH ENTERPRISES INC) - INSURANCE CERTIFICATE (2)OP ID: KH
,a►c _ R-_ CERTIFICATE OF LIABILITY INSURANCE
�� - .. -
DATE D/YYYY)
06/02/11
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. -
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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 endorsements .
PRODUCER 970-635-9400
CONTACT
NAME:
PFS Insurance Group-JT 970.635-9401
4848 Thompson Pkwy, Ste 200
veoNE _ FAx
AIC No at,: A/C No):
E-MAIL
ADDRESS:
Johnstown, CO 80534 -
John Hintzman
-
PRODUCER EARTH-3
CUSTOMER ID #:
INSURERS AFFORDING COVERAGE
NAIC p
"
INSURED Earth Enterprises, Inc.
INSURERA:Mountain States Insurance Grp
Dba Waste- Not Recycling
INSURERS: Underwriters at Lloyds, London
1065 Poplar Street
Loveland, CO 80537
NSURERC:
INSURER D
INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
ADDL
US
POLICY NUMBER
YEFF
MM/DDf1'1'YY
POLICY EXP
MM/DDIYYYY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE a OCCUR
X UND2470402
CPPOO99342
BLKT ADD'L INSURED
PRIMARY/NON-CONTRIBUTORY
06/03/11
06/03/12
EACH OCCURRENCE
$ 1,000,00
PREMISES Ea occurrence
$ 100,00
MED EXP (Any one person)
$ 10,00
PERSONAL S ADV INJURY
IS 1,000,00
X
UND390
GENERAL AGGREGATE
$ 2,000,00
GENT AGGREGATE LIMIT APPLIES PER
POLICY X PRO LOG
PRODUCTS - COMP/OP AGG
$
$
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALLOWNEDAUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTO$ -
Hired/Non-Owned
CPPOO99342
COMP DED: $100
06/03/11
06/03/12
..
COMBINED SINGLE LIMIT
(Ea accdent) --
$ 1,000,00
---
BODILY INJURY (Per person)-
S - -
BODILY INJURY(Per accident)
$ -
X
PROPERTY.DAMAGE '
(Per accident)
$
X
X
$
X
$
A
X
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MAD
CPP0099342
06/03/11
06103112
EACH OCCURRENCE -
$ 4,000,00
AGGREGATE
$ 4,000,00
DEDUCTIBLE
RETENTION IS
b
$
WORKERS COMPENSATION _ _
AND EMPLOYERS' LIABILITY YIN
ANYPROPRIETOR/PARTNERIEXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory In PIN)
If yes, describe under
DESCRIPTION OF OPERATIONS below
_
NIA
_--`----�
- "'__.__
N/A
-
—TIWCSTATU- OTH-
BL. EACH ACCIDENT
E.L. DISEASE -EA EMPLOYEE
'
$
E.L. DISEASE -POLICY LIMIT
$
B
A
Errors & Omissions
POLLUTION
1OLFSPL0008
CPPOO99342
06/03/11
06/03/11
06/03/12
06/03/12
JE&O 1,000,00
IPOLLUTION 250,00
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
R
If required by written contract or written agreement, the certificate holder
is included as additional insured for ongoing operations under general
liability.
CITYOFF
City of Fort Collins
Purchasing Division
P.O. Box 580
Fort Collins„ CO 80522-0580
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
bC1.d2A.-ry.--
:Oi F:Y.1:bbTIT:L•TKQ :1 #7
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
All rights reserved