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HomeMy WebLinkAboutSOURCE ENVIRONMENTAL DBA AET ENVIRONMENTAL - INSURANCE CERTIFICATE (3)DocuSign Envelope ID: B0014C66-923A-4909-A7DE-040547F4F3EC ACC>RO® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYV) 4/30/2014 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 COMT NAME: Henry Ham Agency 645 E. Evans Ave. Denver CO 80250 PHONE FAX 0654 AIC N° - - ADDRESS: EbDRE INSURERS AFFORDING COVERAGE NAIC p INSURER AJChartis Risk Specialists 2349 INSURED SOUE001 INSURER BR nnacQI Assurance 41190 INSURER C:EMC 10SUranCenl Source Environmental, Inc. DBA: AET Environmental, Inc 14-16 Lakeside Lane INSURER D: Denver CO 80212 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: 1626936703 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 NSR SURR WVD POLICY NUMBER POLICY EFF MMIDDrYYYY) POLICY EXP fMMIDDp`YYY1 LIMITS A GENERAL LIABILITY Y Y 18256315 /l/2014 /1/2015 EACH OCCURRENCE $1.000,000 X COMMERCIAL GENERAL LIABILRY X I CLAIMS -MADE ❑OCCUR DAMAGE T NTED PREMISES Ea ocarrence E300,000 MED EXP (My one person) $25,000 PERSONAL & ADV INJURY $1 000 000 X Profess Llab GENERAL AGGREGATE $2 000.000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGO $2000,000 Poll/Professional $1,000,000 RP X POLICY PLOC A AUTOMOBILE LIABILITY Y Y CA1932252 51112014 11/2015 Ea a=ident 1 $1,000,000 X1HIRED BODILY INJURY (Per Person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per actidenQ E PROPERTY DAMAGE Peraccident $ NON-0WNED AUTOS AUTOS . $ A X UMBRELLA LIAB X OCCUR Y Y 18259214 /112014 /1/2015 EACH OCCURRENCE $9,000,000 AGGREGATE $9,000.000 EXCESS LIAB CLAIMS -MADE DED Ix I RETENTIONS 10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN y 3445583 /1/2014 /112015 X I WC8TATU- OTH- LIMANY E.L. EACH ACCIDENT $1,000,000 PROPRIETOR/PARTNERIEXECUTIVE❑ OFFICERIMEMBER EXCLUDED? NIA E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, deM:nbe under DE SCRIPTION OF OPERATIONS belov E.L. DISEASE - POLICY LIMIT $1000000 C Equipment Floater N' 4X75445 /1I2014 11/2015 Equipment Floater $50,000 Misc Tools Rented Equipment N N Misc Tools $25,000 Rented/Leased Equip $50,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ANach 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 performs attached. 78011 (5/01). Limit for rented equipment other than a vehicle is $50,000. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TO WHOM IT MAY CONCERN If you need to be listed ACCORDANCE WITH THE POLICY PROVISIONS. here please contact our office AUTHORIZED REPRESENTATIVE XXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXX CO 80219 ©1988.2010 ACORD CORPORATION ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD