Loading...
HomeMy WebLinkAboutSOURCE ENVIRONMENTAL DBA AET ENVIRONMENTAL INC - INSURANCE CERTIFICATEFrom: Micki Weeder FaxID:303-744-0654 Page 1 of 3 Date:9/13/2012 02:50 PM Page:1 of 3 Fax HENRY HAM AGENCY P.O. BOX 100547 645 E. EVANS DENVER, CO 80210 www.henryham.com Phone: (303) 744-1341 Fax: (303) 744-0654 Email: mickl@henryham.com From: Micki Weeder To: City of Ft Collins Pages: 3 Company: Date: 9/13/2012 02:50:38 PM Fax: (970) 221-6707 Subject: Citv of Fort Collins Phone: Message: Please find the certificate requested attached. Thank You, fA M. From: Micki Weeder FaXID:303-744-0654 Page 2 of 3 Date:9/13/2012 02:50 PM Page:2 of 3 SOUE001 OP ID: MW �zo, CERTIFICATE OF LIABILITY INSURANCE a�o� DATDYVVV) 09113 09/13/12 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 endorsement(s). PRODUCER 303-744-1341 Henry Ham Agency, Inc. P.O. Box 100547 303-744-0654 CONTACT NAME PHONE FAX AIC No Ext :(A/C, No): 645 E. Evans Ave. Denver, CO 80250 E-MAIL ADDRESS: Hank Ham INSURER(S) AFFORDING COVERAGE NAIC N INSURER A: Chartls Risk Specialists INSURED Source Environmental, Inc. INSURER B: Plnnacol Assurance DBA: AET Environmental, Inc 14-16 Lakeside Lane Denver, CO 80212 INSURER C:Travelers Insurance INSURER D:Zurich American 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR rypE OF INSURANCE INSR VIVID POLICY NUMBER POLICY EFF MMIDDIVVVV POLICY EXP MMIDDIVVVV LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X 18256315 05/01/12 05/01/13 DAMAGE TO RENTED PREMISES Ea occurrence $ 300,000 CLAIMS [VIOCCUR MED EXP (Any one person) $ 25,000 X Pollution Liab 18256315 05/01/12 05/01/13 PERSONAL a ADV INJURY $ 1,000,000 X Professional Liab GENERAL AGGREGATE $ 2,000,000 18256315 05/01/12 05/01/13 GENL AGGREGATE LIMIT APPLIES PER'. PRODUCTS-COMOOPAGO $ 2,000,000 RD CY X PRO LOC Poll/Prof $ 1,000,000 AUTOMOBILE LIABILITY COMBI NED SINGLE LIMIT Eaacciden[ $ 1,000,000 BODILY INJURY (Per person) $ A ANY AUTO CA1932252 05/01/12 05/01/13 ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS ERTV DAMAGE $ NONOWNEDPROP HIRED AUTO AUTOS Per a cciden[ $ 11 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 A EXCESS LIAB CLAIMSMADE18259214 05/01/12 05/01/13 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION X WCSTATU- X OTH- TORY LIMITS ER AND EMPLOYERS' LIABILITY YIN E.L. EACH ACCIDENT $ 1,000,000 B ANY PROPRIETORIPARTNERIEXECUTIVE 9691487-01 05/01 /12 05/01/13 OFFICERPAEMBER EXCLUDED? (Mandatory in NH) NIA 3445583 05/01/12 05/01/13 E.L. DISEASEEAEMPLOYEE $ 1,000,000 If yes describe under DESCRIPTION OF OPERATIONS below FIT .DISEASE -POLICY LIMIT $ 1,000,000 C Equipment Floater 660-59061-866 05/01/12 OS/01/13 Misc Tool 25,000 Deductible Rented Eq 50,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Fort Collins is included as Additional Insured with respects to the General Liability coverage when required by written contract. CERTIFICATE HOLDER CANCELLATION CITYF-2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins Purchasing Division PO BOX 580 AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522 cfi r_, '" tlli ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD From: Micki Weeder FaxID:303-744-0654 Page 3 of 3 Date:9/13/2012 02:50 PM Page:3 of 3