HomeMy WebLinkAbout109244 WASTE MANAGEMENT OF COLORADO INC - INSURANCE CERTIFICATE (2)AC"R"' CERTIFICATE OF LIABILITY INSURANCE
lh� 1 / l /2020
DATE(MMIDDNYYY)
12/4/2018
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 have ADDITIONAL INSURED provisions or 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 LOCKTON COMPANIES
3657 BRIARPARK DRIVE, SUITE 700
HOUSTON TX 77042
866-260-3538
NAME:
PHONE Arc, Ext : FAX
Arc, No
E-MAIL
ADDRESS:
INSURERS AFFORDING COVERAGE
NAIC #
INSURER A: ACE American Insurance Company
22667
INSURED WASTE MANAGEMENT HOLDINGS, INC. & ALL AFFILIATED,
1300436 RELATED & SUBSIDIARY COMPANIES INCLUDING:
WASTE MANAGEMENT OF NORTHERN COLORADO
500 EAST VINE DRIVE
FORT COLLINS CO 80524
INSURER B : Indemnity Insurance Co of North America
43575
INSURER C : ACE Fire Underwriters Insurance Company
20702
INSURER D :
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: 3429072 REVISION NUMBER: XXXXXXX
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
INSD
SUBR
WVD
POLICY NUMBER
POLICY EFF
MM/DDNYYY
POLICY EXP
MM/DD/YYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE � OCCUR
XCU INCLUDED
Y
N
HDO G71212993
1/1/2019
I/1/2020
EACH OCCURRENCE
5,000,000
PREMISESOEa occurrrence
5,000,000
X
MED EXP (Any oneperson)
XXXXXXX
X
ISO FORM C000010413
PERSONAL & ADV INJURY
$ 5,000,000
L AGGREGATE LIMIT APPLIES PER:
POLICY JECT LOC
POTHER:
GENERAL AGGREGATE
$ 6 00O000
PRODUCTS - COMP/OP AGG
$ 6000 000
$
A
AUTOMOBILE
LIABILITY
ANY AUTO
AUTOS ONLY SCHEDULED
AUTOS ONLY X NON-OWNED
ONLDY
MCS-90
Y
N
MMT H2527863A
1/1/2019
1/1/2020
Ee BINEDtSINGLE LIMIT
$ 1,000,000
X
BODILY INJURY (Per person)
${XXXXXX
X
BODILY INJURY (Per accident
$ XXXXXXX
X
Per accede 'DAMAGE
$XXXXXXX
X
$ XXXXXXX
A
X
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
Y
N
XOO G27929242 004
I/1/2019
I/1/2020
EACH OCCURRENCE
$ 15,000,000
AGGREGATE
$ 15,000,000
DIED I I RETENTION $
$ XXXXXXX
B
A
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
in ERPROPRIETOR/EXCLUDED?ECUTIVE —1
(OFY ICEMandatory
(Mandatory in NH)
yes. describe under
DESCRIPTION OF OPERATIONS below
NIA
N
WLR C65435846 (AOS)
WLR C65435809 (CA & MA
SCF C65435883( ) )
1/1/2019
1/1/2019
I/1/2019
1/l/2020
1/1/2020
1/1/2020
_
PER OTH-
X STATUTE ER
E.L. EACH ACCIDENT
$ 3 000,000
3
E.L. DISEASE - EA EMPLOYEE
3,000,000
E.L. DISEASE -POLICY LIMIT
3,000, 000
A
EXCESS AUTO
LIABILITY
Y
N
_
XSA H25278598
_
1/1/2019
l/l/2020
COMBINED SINGLE LIMIT
$9,000,000
(EACH ACCIDENT)
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
ADDITIONAL INSURED IN FAVOR OF THE CITY OF FORT COLLINS (COLOR -ADO) (ON ALL POLICIES EXCEPT WORKERS'
COMPENSATION/EL) WHERE REQUIRED BY WRITTEN CONTRACT.
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.
3429072
AUTHORIZED REPRESENTATIVE
CITY OF FORT COLLINS
P.O. BOX 580
FT. COLLINS CO 80524
ACr1Rn 94 /9n1R/n4i
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