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HomeMy WebLinkAbout664026 EARTH ADVANTAGE INC - INSURANCE CERTIFICATEE (MM/DD(YYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE 111% 76/3/2019 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 CONTACT NAME: Kelll Lucey Durham and Bates Insurance PHONE FAX 720 SW Washington St. (A/C L . EXt): 503-224-5170 _ AA/C.No) 503-221-0540 E-MASte 250 ADDRESS: kellil@dbates.com Portland OR 97205-3554 INCI IRFRrCt AFFnpnimr: r.nVFRArF NAlf,A INSURER A: Axis Surplus Insurance Company 26620 INSURED EARTADV-01 INSURER B: Saif Corporation 36196 Earth Advantage, Inc. 623 SW Oak St, Ste 300 INSURERC: Portland OR 97205 INSURERD: INSURER E : COVERAGES CERTIFICATE NUMBER:438128267 REVISION NUMBER: THIS 15 TO CERTIFY" THAT THE FOLiClES OF INSURANCE LISTED BELOW HAVE BEEN !SSIJED TO THE INSURED NAMED .ABOVF 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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER MM/DDY/Y LTR YYY MM D/Y DYYY LIMITS LT A X COMMERCIAL GENERAL LIABILITY EMP19001075 6/1/2019 6/1/2020 EACH OCCURRENCE $1,000,000 CLAIMS -MADE � OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY JECT PRO ❑ LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: A AUTOMOBILE LIABILITY EMP19001075 6/1/2019 6/1/2020 COMBINED SINGLE LIMIT Ea accident $1,000,000 BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per ac_c_ident $ X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DIED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE 972615 6/1/2019 6/1/2020 X I PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? � NIA E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATICNS beiuw E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Additional Insured (see attached form) CERTIFICATE HOLDER GANGtLLA I IUN City of Fort Collins PO Box 580 Fort Collins CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. HIRED AUTO AND NONOWNED AUTO LIABILITY SCHEDULE Insurance is provided only with respect to those coverages for which a specific premium charge is shown: Coverage Sublimits of Insurance Additional Premium A. Hired Auto Liability $1,000,000 Each CLAIM $1,000,000 General Aggregate $Included B. Nonowned Auto Liability $1,000,000 Each CLAIM $1,000,000 General Aggregate $ Included Regardless of the number of coverages involved: 1. the Sublimit of Insurance shown in this endorsement for Each CLAIM is the most WE will pay for all loss for DAMAGES and CLAIM EXPENSE arising out of any one CLAIM; and 2. the Sublimit of Insurance shown in this endorsement for the General Aggregate is the most WE will pay for all loss for DAMAGES and CLAIM EXPENSE for each POLICY PERIOD. The Sublimits of Insurance shown for A. and B. in the Schedule above are part of, and not in addition to, the Limits of Insurance shown on the Declarations. WE will not be obligated to undertake or defend any SUIT or proceeding, which is subject to the Sublimits of Insurance stated in this endorsement, after the applicable Sublimits of Insurance are exhausted. HIRED AUTO LIABILITY The insurance provided under COVERAGE A (SEC- TION 1) applies to BODILY INJURY or PROPERTY DAMAGE arising out of the maintenance or use of a HIRED AUTO by YOU or YOUR EMPLOYEES in the course of YOUR business. NONOWNED AUTO LIABILITY The insurance provided under COVERAGE A (SEC- TION I) applies to BODILY INJURY or PROPERTY DAMAGE arising out of the use of any NONOWNED AUTO in YOUR business by any person other than YOU. With respect to the insurance provided by this endorsement: The exclusions, under COVERAGE A (SECTION 1), other than exclusions a., b., d., f. and i. are deleted and the following exclusions are added: 1. BODILY INJURY: (b) To the spouse, child, parent, brother or sister of that EMPLOYEE as a consequence of paragraph (a) above. This exclusion applies: (a) Whether the insured may be liable as an employer or in any other capacity; and (b) To any obligation to share DAMAGES with or repay someone else who must pay DAMAGES because of the injury. This exclusion does not apply to: (a) Liability assumed by the insured under an INSURED CONTRACT; or (b) BODILY INJURY arising out of and in the course of domestic employment by the insured unless benefits for such injury are in whole or in part either payable or required to be provided under any workers compensation law. (a) To an EMPLOYEE of the insured arising out of 2. PROPERTY DAMAGE to: and in the course of employment by the insured; or Includes copyrighted material of ISO Properties, Inc., with its permission. Copyright, ISO Properties, Inc., 1994 Page 1 of 2 PG EL 022 0210 Page 1 of 2