The URL can be used to link to this page

Home My WebLink About304997 BELFOR ENVIRONMENTAL INC - INSURANCE CERTIFICATE (4)CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) Da712014 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(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 certificate does not confer rights to the certificate holder in lieu of such endomement(s). PRODUCER Aon Risk Services Central, Inc. Southfield MI Office CONTACT NAME. P,11.NE. Eat): (966) 283-7122 IF." No: (8DO) 363-0105 E4AAL ADDRESS: 3000 Town Center Suite 30GO INSURER(S) AFFORDING COVERAGE NAIL R Southfield MI 48075 USA INSURED INSURER Pinnacol Assurance Company 41190 Belfor Environmental. Inc. 5075 Kalamath Street Denver Co 80221 USA INSURER B: National union Fire Ins Co of Pittsburgh 19445 INSURER C: The Insurance Co of the State of PA 19429 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570055667326 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. Limits shown ere as requested S L TYPE OF INSURANCE INSD IWO POLICYNUMBER MMIDO POLICY EXP MIND LIMITS X I COMMERCIALGENERALLU,BILITY CL EACHOCCURRENCE S2,000,000 CLAIMS -MADE OCCUR SIR applies per policy ter is & condi ions PREMISES Ea oparrence $2,000,000 MED EXP(My one person) S100,000 PERSONAL S ADV INJURY S1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S4,000,000 POLICY ❑X PRO, ❑X LOC JECT PRODUCTS -COMPIOP AGG $4,000,000 OTHER' B AUTOMOBILE LIABILITY CA 510-17-08 07/01/201407/01/2015 COMBINEDSINGLELIMIT Mairocicentl S2,000,000 BODILY IWURY(Per pewn) X ANY AUTO BODILY IWURY(Per auirlent) X ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED X MIRED AUTOS AUTOS PROPERTY DAMAGE Pere¢idant % Cdl Ded$1,000 X CPnp DW S1,000 UMBRELLADAB OCCUR EACH OCCURRENCE AGGREGATE EXCESSB LUI CIAI MS4iADE DED IRETENTION C A WORKERS COMPENSATION AND EMPLOYERS'LIFBILRY ANYPROPRIETOR I PARTNER I EXECUTIVE OFFICERIMEMBER f UUDEDi (Nandatoryin NH) NIA wc034157355 ADS 4051232 CO 07/01/2014 12/Ol/2013 Ol 201 077YIN 12/Ol/2014 PER OH. X STATUTE E.L. EACH ACCIDENT 51,000,000 E.L. DISEASE -EA EMPLOYEE S1,000,000 n yyee desalne and I DESCPoPTION OF OPERATIONS Irelow E.L. DISEASE-POMY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AddlOunal Remarks Schedule, may M attaclwd if more apace la required) City of Fort Collins is included as Additional insured in accordance with the policy provisions of the General Liability policy. CERTIFICATE HOLDER CANCELLATION 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 AUTHORIZED REPRESENTATIVE Attn: Purchasing Division PO BOX 580 Fort Collinsli CO 80522 USA 01988.2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000005415 LOC #: A os ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY ACT Risk Services Central, Inc. NAMED INSURED Belfor Environmental, Inc. POLICY NUMBER See Certificate Number: 570055667326 CARRIER see Certificate Number: 570055667326 NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for Dolicv limits. INSR LTR TYPE OF DNSURANCE ADDL msD SUBR WVD POLICY NUMBER POLICY EFFEKTWE DATE (MM/DDMYY) POLICY EXPIRATION DATE (MM/DD/YYYY) WMITS WORKERS COMPENSATION B N/A WC034157349 CA 07/01/2014 07/01/2015 C N/A WC034157354 MA, ON, WA, WI 07/01/2014 07/01/2015 C N/A WC034157352 IL, KY, NC, UT 07/01/2014 07/01/2015 B N/A WC034157353 NJ, PA 07/01/2014 07/01/2015 C N/A WC034157351 A7, GA, VA 07/01/2014 07/01/2015 B N/A WC034157350 FL 07/01/2014 07/01/2015 ACORD 101 (2008/01) 02008 ACORD CORPORATION. All rights reserved. The ACORD now and logo are registered marks of ACORD