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HomeMy WebLinkAboutAPPLIANCE RECYCLING CENTERS OF AMERICA INC - INSURANCE CERTIFICATE (3)AL~`"R" CERTIFICATE OF LIABILITY INSURANCE `/ DATE /YYVV) 04101/2015 2015 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 Marsh USA Inc. 333 South 7th Street, Suite 1400 CONTACT PHONE PHONEFAX No: AC E-MAIL ADDRESS: Minneapolis, MN 55402-2400 INSURERS AFFORDING COVERAGE NAIC N INSURER A, Liberty Mutual Fire Insurance Company 23035 365177-ARCA-GAWX-15-16 _ INSURED Appliance Recycling Centers of America, Inc. INSURER 8 : The First Liberty Insurance Corporation 33588 INSURER C : N/A WA INSURER D : 7400 Excelsior Blvd Minneapolis, MN 55426 INSURER E INSURER F : rn%ICDAf 4t CFGTICICATF MIIMr3FR• CHI-nnAQ3Q8R8AA RFVISION Nl1MRFR-18 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 SUER POLICY NUMBER POLICY EFF MMIDDNYYY POLICY EXP MMIDDfYYYY OMITS A GENERAL LIABILITY TB2-Z91A26090-105 04/01/2015 04/01/2016 EACH OCCURRENCE $ 1,000.000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea omu ence 1,000,000 $ MED EXP (Any one person) $ 10,000 JADDL CLAIMS -MADE a OCCUR PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2,000,000 $ POLICY PRO- X LOC B AUTOMOBILE LIABILITY AS6-Z91426090-015 04/01/2015 04/01/2016 COMBINED SINGLE LIMIT a accident 1,000,000 BODILY INJURY (Per person) $ X AINY AUTO CA,CO,GA,IL,KY,MN,MO,OH,TX,WA BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTO S AUTOS X X NON -OWNED HIRED AUTOS AUTOS PROPERTYDAMAGE Per accident - $ UYBREUA UAB OCCUR EACH OCCURRENCE $ AGGREGATE III E1rCESE LIAR CLAIMS -MADE RETENTION $ $ A WORKERS COMPENSATION See Attached 3M01/2015 04I0112016 X VNC STATU- OTH- ILIMITS B AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YER- IN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA See Attached 04/01/2015 04/01/2016 E.L. EACH ACCIDENT $ SEE ATTACHED E.L. DISEASE - FA EMPLOYE SEE ATTACHED $ E.L. DISEASE - POLICY LIMIT $FF ATTACHED $ It yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space is required) 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 by written contract. Waiver of subrogation is applicable where required by written contract in favor of the City of Fon Collins. CFRTIFICATF 411711 f1FR CANCELLATION The City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Atln. Purchasing Dept. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 580 ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi MukherjeeEsti+� oo �t A�c.a�awe U 19BB-2010 AGOKU GUKPUKA I IUN. All nignts reserVea. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 365177 _ LOC #: Minneapolis A�ORO® ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh USA Inc Appliance Recycling Centers of America, Inc. POLICY NUMBER 7400 Excelsior Blvd Minneapolis, MN 55426 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers Compensation: Carrier: Liberty Mutual Fire Insurance Company Policy Number: WC2191426090-045 (CO, GA, IL, KY, MN, MO, NY, OR, TX) Policy Dates. 04I0112015 - 04/01/2016 Workers Comp statutory limits apply E.L. Each Accident: $500,000 E.L. Disease Ea Employee: $500,000 E.L. Disease- Policy Limit: $500,000 Stop Gap Coverage for OH and WA are included on this policy. Camer The First Liberty Insurance Corporation Policy Number: WC6291426090-075(CA) Policy Dates: 0410112015 - 04/01 /2016 Workers Comp statutory limits apply E.L. Each Accident: $1,000,000 E.L. Disease- Ea Employee: $1,000,000 E.L. Disease. Policy Limit $1,000,000 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD