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HomeMy WebLinkAboutAPPLIANCE RECYCLING CENTERS OF AMERICA INC - INSURANCE CERTIFICATECERTIFICATE HOLDER © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) AUTHORIZED REPRESENTATIVE CANCELLATION CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) JECT LOC POLICY PRO- GEN'L AGGREGATE LIMIT APPLIES PER: CLAIMS-MADE OCCUR COMMERCIAL GENERAL LIABILITY GENERAL LIABILITY PREMISES (Ea occurrence) $ DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ DED RETENTION $ CLAIMS-MADE OCCUR $ AGGREGATE $ UMBRELLA LIAB EACH OCCURRENCE $ EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe under DESCRIPTION OF OPERATIONS below (Mandatory in NH) OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNED AUTOS AUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: Carrier: The First Liberty Insurance Corporation� Policy Dates: 04/01/2014-04/01/2015� E.L. Each Accident: $1,000,000� �� 2 2 E.L. Disease- Ea Employee: $500,000� E.L. Each Accident: $500,000� Minneapolis Policy Number: WC2-Z91-426090-044 (CO, CT, GA, IL, KY, MN, NY, NC, TX)� Carrier: Liberty Mutual Fire Insurance Company� Workers Comp statutory limits apply� Policy Dates: 04/01/2014-04/01/2015� �� �� � Workers Compensation:� Certificate of Liability Insurance 365177 E.L. Disease- Policy Limit: $500,000� � Policy Number: WC6-Z91-426090-074 (CA)� E.L. Disease- Ea Employee: $1,000,000� Workers Comp statutory limits apply� Marsh USA Inc.� Centers of America, Inc.� Appliance Recycling� Minneapolis, MN 55426 7400 Excelsior Blvd� E.L. Disease- Policy Limit: $1,000,000� 25 Stop Gap Coverage for OH and WA are included on this policy.� PROPERTY DAMAGE $ $ $ $ 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 ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) 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). The ACORD name and logo are registered marks of ACORD COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: INSURED PHONE (A/C, No, Ext): PRODUCER ADDRESS: E-MAIL FAX (A/C, No): CONTACT NAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1,000,000 04/01/2015 TB2-Z91-426090-104 Manashi Mukherjee X CHI-004939868-01 SEE ATTACHED See Attached 33588 of Marsh USA Inc. N X 2,000,000 04/01/2014 18 AS6-Z91-426090-014 04/01/2015 A 2,000,000 1,000,000 X N/A The First Liberty Insurance Corporation SEE ATTACHED X �� X X 05/22/2014 04/01/2014 The City of Fort Collins, officiers, agents and employees are included as additional insured where required by written contract with respect to General Liabililty and Auto Liability. General Liability is primary and non- contributory over any existing insurance and limited to liability arising out of the operations of the named insured and where required by written contract. Per project aggregate applies to General Liability as required 04/01/2014 Fort Collins, CO 80522 The City of Fort Collins� by written contract. Waiver of subrogation is applicable where required by written contract in favor of the City of Fort Collins.�� X A N/A 365177-ARCA-GAWX-14-15 10,000 04/01/2015 1,000,000 B CA,CO,GA,IL,KY,MN,NC,OH,TX,WA 23035 1,000,000 SEE ATTACHED See Attached 333 South 7th Street, Suite 1400� Marsh USA Inc.� Minneapolis, MN 55402-2400 Centers of America, Inc.� Appliance Recycling� Minneapolis, MN 55426 7400 Excelsior Blvd� 04/01/2014 PO Box 580� Attn: Purchasing Dept.� B 04/01/2015 Liberty Mutual Fire Insurance Company