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HomeMy WebLinkAboutSOURCE ENVIRONMENTAL DBA AET ENVIRONMENTAL - INSURANCE CERTIFICATEACORa' CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYY)(I 5/2/2013 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. THISCERTIFICATEOF 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(les) 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 certif_Icate.Aoes.not Confer. rights to.the certificate holder in lieu of such endorsements . -- —; '`' " • "'- `- -- - ' PRODUCER y-,- , '" - 1.Vy: a. E .d•,. Henry Ham Agency .. ... _.__.._.. _. 645 E. Evans Ave. - Denver CO 80250 N NAME: PHONE. :..*...,.FAX,r�• - - we Np ` - - (AI54 ADDREss: INSURERS AFFORDING COVERAGE - NAIC N INSURER A:Chartis Risk Spec al sts INSURED SOUE001 INSURER B:PinnacQl Assurance INSURER C:TraVelerS Source Environmental, Inc. DBA: AET Environmental, Inc 14-16T—a <eside Lane INSURER D Denver CO 80212 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1331552127 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 ADDLSUBR INSR WVD POLICY NUMBER POLICYEFF M MMIDDYEXP IYYYY LIMITS A GENERAL LIABILITY Y Y 18256315 /112013 /l/2014 EACH OCCURRENCE $1,000,000 uAMAGLiO PREMISES Ea occurrence $300.000 x COMMERCIAL GENERAL LIABILITY X CLAIMS-MADE1:1 OCCUR MED EXP(Any one person) $25.000 PERSONAL &ADV INJURY $1,000000 - GENERAL AGGREGATE $2,000,000 •: - , ,- _,._.._ GEN'L AGGREGATE .. .. :: •POLICY LIMIT APPLIES PER:.. r PRO, ' -LOC ", -, _ PRODUCTS - COMP/OP AGG $2,000,000- ....., .. _ _- -..... _..... ....... ,r n $ A AUTOMOBILE LIABILITY •, ;• +---: Y- Y• CA1932252 _ - /l/2013 5/l/2014 ., • , , ... Ea accident $1,000 000 BODILY INJURY (Per Person) $- ' ANY AUTO.: 't " -'• ' •' • ' � ' '- 1 • .. "' ' .•' "• ., : ' AU OWNED SCHEDULED AUTOS AUTOS .7. BODILY INJURY (P er accitlenq $ • - • -. NON-0VJNED HIRED AUTOS AUTOS F PROPERTY DAMAGE 'Per accident $ A X UMBRELLA LIAR X OCCUR Y Y 1/259214 11/2013-- /1/2014 EACH OCCURRENCE $4,000,000 AGGREGATE $4,000,600 EXCESS LIAR CLAIMS -MADE OED X RETENTION$ 10,000 1 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N y 445583 11112111 /1/2014 X VJCSTAT'J- OTH- EL EACH ACCIDENT $1,000,000 ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? NIA E.L. DISEASE - EA EMPLOYE $1,000,000 - (Myandatory In NH) es des�b. under DESCRIPTION OF OPERATIONS below E. L. DISEASE -POLICY LIMIT $1.000.000 C Equipment Floater N 60-590fiLBfi6 /1/2013 Equipment Floater $50.000 Misc Tools Rented Equipment N N �/l/2014 Mlsc Tools $25.000 Rented/Leased Equip $50,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AIIAch ACORD 101, Additional Remarks Schedule, If more space Is required) Certificate holder, its elected & appointed officials, officers, employees, agents and representatives are included as Additional Insured with respects to the Liability coverage stated above performs attached 110029 (10/11)when required by written contract. 78123(06/01). A waiver of subrogation applies in favor of the Additional Insured with respects to the Liability coverage and workers compensation policy per forms attached. 78011 (5/01). City of Fort Collins P 0 Box 580 Fort Collins CO 80522 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 © 1988.2010 ACORD ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD ENDORSEMENT N.O. 20 This endorserhent effective 1201 AM', May 01, 2013 FormsapartofPolicyNo PROP j.@256315 Issued to: iSOURCE ENVIRONMENTAL, INC By: CHARTIS'SPECIALTY INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY'; ADDITIONAL INSURED -; DESIGNATED ENTITY ,.PRIMARY AND NON-CONTRIBUTORY%.ENDORSEMENT This endorsementimodifies.insurance provided under the following: COMMERCIAL. GENERAL LIABILITY AND PROFESSIONAL, LIABILITY POLICY It.is hereby agreed that solely as''r4spects COVERAGE A. BODILY INJURY.AND PROPERTY DAMAGE LIABILITY and COVERAGE B. - PERSONAL, AND ADVERTISING INJURY LIABILITY, SECTION II..- WHO IS ,AN INSURED is .amended to include as an additional insured the person(s)..or organizations) shown: -in the Schedule below, but only with respect to, liability: for bodily injury, property damage or personal ;and advertising injury arising out:of ongoing 'operations; performed. try'you;or on your behalf, for that insured or; caused,. in whole or in;part...by your work performed: for that additional ihsured:,and included in, the products -co nipleted operations hazard. Coverage is not afforded for the additional insureds` own;liability which 'arises solely out ofits `sets or omissions. In the -event that.a, written contract, .written' -agreement 'or permit,requires this insurance ito-be primary for any person or organization , L om,you agreed, this insurance shall, be primary and we will not seek'contributionsfrom any such other insurance issued.to such person,pi organization provided that,such written contract, Written agreemeritor permit is executed'priwl;t ;the occurrence or offense. The entities:scheduled above are covered under this Policy only for, limits.of-liabilityup to but not exceeding the amount required by the written contract with the insured and.subject to the limits of`liability.of this Policy - SCHEDULE Name of Additional Insured person(s) or0iganization(s): BLANKET WHERE REQUIRED BY WRITTEN, CONTRACT All other terms; condmons and exclusions shall remain the same:; AUTHORIZED REPRESENTATIVE or countersignature {in states,vvhore applicable) 110029 (10/11)1 PAGE 1 OF C15074 ENDORSEMENTAO. 11 This:endorseni6nt, effective'12:01 AM, May 01, 2013 F,orms.a part.of°Rolicy.No:. PROP 184M15 Issued to: SOUR CE'ENVIRONMENTAL,, INC By: ,CHRRTIS.SRECIALTY INSURANCE COMPANY THIS. ENDORSEMENT CHANGES THE:POLICY. PLEASE READ: IT CAREFULLY. ADDITIONAL INSURED/.PRIMARY COVERAGE ENDORSEMENT' In consideration of an additional premium of $INCLUDED it is' hereby agreed that the following, is included as an Additional Insured as respects Coverage A and B but only;as respects liability arising out of your ongoing operations performed for the Additional Insured by or,for you. Additionallrisu'red< BLANKET WHERE REQUIRED BY-WRITTEN:CONTRACT This not apply to bodily injury or property damage arising iout of the sole negligence.orwillful misconduct of, or for' defects in design furnished"by"the,Addiponal Insured. As respects the coverage afforded the Additional'Insured, this'insurance is primary and non-contributory, and our obliga- tions are not affected by any other insurance carried by such Additional Insured whether: primary,, excess, contingent, or on any other: basis. This endorsement•does- not increase tithe Company�s limits of liability as specified in the Declarationsofl,this policy. All other .terms, conditions; and exclusions shall remain the same:, AUTHORIZED REPRESENTATIVE or countersignature (in states where applicable) A123 (6/01j PAGE 1 OF 1 CI1486 ENDORSEMENTAO. 12 This-endorsernent,reffeclive 12:01 AM, May 01, 2013 Forms apart ofpolicy.Mo: PROP.1825W15 Issuedlo: SOURCE ENVIRONMENTAL, INC By: .CHARTIS.SPECIALTY INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE.POLICY. PLEASEREAD'IT:CAREFULLY. .WAIVER OF.SUBROGATION -SPECIFIC PERSON:•OR ORGANIZATION This endorsement modifes•insurance provided under the following:, COMMERCIAL GENERAL, LIABILITY AND PROFESSIONAL: 1ABILITY'.POLICY SCHEDULE Name of Person or,Organization: BLANKET WHERE REQUIRED BY WRITTEN CONTRACT (If no entry appears above, information required to complete this endorsement will, be shom in the Declarations: as applicable to this endorsement) It is hereby agreed 'that SECTION IV, Conditions, -paragraph 9 Subrogation is;amended to include-theJollowing: We agree to waive this right of sub(ogatlon. against the person oi,orgaizatiop=;shown in: the Schedule. above to. the extent that you had„prior to an=occurrences:or, claim, a .wriden,:agreement to.waive :such rights. •Al other terms, conditions, and exclusions shall remain the'same.: AUTHORIZED REPRESENTATIVE; or countersignatuie (in states,where. applicable) 78011 15r01). :Includes copyrighted material of'Insurance Services PAGE 1 OF 1 CI1442- Offices,; Inc., Wth its permission. Insurance Services office, Inc-1992 PINN/.1COL ASSURANCE INSURED: Source Environmental, Inc. dba Aet Environmental 14 Lakeside Lane Denver, CO 80212 ENDORSEMENT: Blanket Waiver of Subrogation 7501 E Lowry Blvd Denver, CO 80230-7006 Phone: (303) 3614000 / (800) 873-7242 Fax: (303) 361-5000 1 (888) 329-2251 NCCI #: WC000313B Policy #: 3445583 AGENT: Henry Ham Insurance Agency, Inc, PO Box 100547 Denver, CO 80210 (303)744-1341 We have the right to recover our payments from anyone liable for any injury covered by this policy. We will not enforce our right against the person or organization named in the schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us. This agreement shall not operate directly or indirectly to benefit anyone not named in the schedule. 6141.1:10D14: To any person or organization when agreed to under a written contract or agreement, as defined above and with the insured, which is in effect and executed prior to any loss. Effective Date: May 1, 2013 Expires on May 1, 2014 Pinnacol Assurance has issued this endorsement May 1, 2013, Jeff Bunn Underwriter Plnnao Assurance • 7501 E Lwny BNd' Denver, CO 8023D Page 1 of t PINNAVJEB - OS 01/2013 18'. M:17 M 5583 Updaiad. O MWN07 359 E