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HomeMy WebLinkAbout664026 EARTH ADVANTAGE INC - INSURANCE CERTIFICATE (2)® DATE (M M/DD/YYYY) ACORNCERTIFICATE OF LIABILITY INSURANCE ��. 6/3/2019 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 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 Durham and Bates Agencies, Inc. PHONE Kelli Lucey -- - FAX 720 SW Washington St. Ste250 A/C. No. Exttl: 503-224-5170 A/c No): 503-221-0540 E-MAIL Portland OR 97205-3554 ADDRESS: kellil dbates.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Ohio Security Insurance Company 24082 INSURED INSURER B: AXIS Surplus Insurance Company 26620 Earth Advantage, Inc. 623 SW Oak St, Ste 300 INsuRERc: Saif Corporation 36196 Portland OR 97205 INSURER D : INSURER E : INSURER F : COVFRAGFS CERTIFICATE NUMBER: 21177nri3R7 REVISION NUMBER - THIS 13 TO vERTif i THAT THE PC =0 Cr HNSURANCE LISTED SELO'A' HAVE PEEN ISSUED TO THE NNSURED NAMED ABOVE FOR THE FCLICY ^ERIOD 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 SUBR POLICY NUMBER EFF MM DPOLIDNYYY MCY M LICY EXP DDN Y LIMITS B X COMMERCIAL GENERAL LIABILITY EMP19001075 6/1/2019 6/12020 EACH OCCURRENCE $ 1,000,000DAMAGE CLAIMS -MADE 1K OCCUR PREM SESOEa occTu ence $100,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO JECT ❑ LOC PRODUCTS - COMP/OP AGG $ 2,000,000 Host Liquor $ Included OTHER: B AUTOMOBILE LIABILITY EMP19001075 6/12019 6112020 COMBINED SINGLE LIMIT Ea accident $ 1 ODO 000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED X HIRED AUTOS X AUTOS B UMBRELLA LIAB X OCCUR EMX19000258 6/12019 6/1202O EACH OCCURRENCE $ 5,000,000 X AGGREGATE $5,000,000 EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N 972615 6/12019 6/12020 X PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED9 �N N/A E.L. EACH ACCIDENT $ 1,000,000 - (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L DISEASE - POI !CY LIMIT $ 1 000 000 A Bus Pers Prop BKS57974537 6/12019 6112020 Limit 165.000 B Professional Liability EMP19001075 6/12019 6/12020 Aggregate (ded $51k) 2,000,000 Each Occur. 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 CANCELLATION 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 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) 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 line 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 PGI EL 022 0210 Page 1 of 2