HomeMy WebLinkAboutCONTAMINATION CONTROL AND CERTIFICATION HOLDINGS I - INSURANCE CERTIFICATEACORO® CERTIFICATE OF LIABILITY INSURANCE
6/15/2020
DATE(MM/DD/YYYY)
1 6/11/2019
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 Lockton Companies
444 W. 47th Street, Suite 900
Kansas City MO 64112-1906
(816) 960-9000
NAMEHo
E FAX
A/C, NO, Ext : A/c, No):
E-MAIL
ADDRESS:
INSURERS AFFORDING COVERAGE
NAIC #
INSURER A: Starr Surplus Lines Insurance Company
13604
INSURED CONTAMINATION CONTROL AND CERTIFICATION
1455554 HOLDINGS, INC
TECHNICAL SAFETY SERVICES LLC
INSURER B : Starr Indemnity & Liability Company
38318
INSURER C
INSURER D :
620 HEARST AVE
INSURER E :
BERKELEY CA 94710
INSURER F :
COVERAGES"" CERTIFICATE NUMBER: 15727707 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/DDIYYYY
POLICY EXP
(MM/DDIYYYYI
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE � OCCUR
N
N
1000065716191
6d 5/2019
6/15/2020
EACH OCCURRENCE
$ 1,000,000
PREMISES (Ea ocE TO currrence
50,000
MED EXP (Any oneperson)5,000
PERSONAL & ADV INJURY
$ 1,000 000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY JECT LOC
OTHER:
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
B
AUTOMOBILE
LIABILITY
ANY AUTO
AAUTOS ONLY ED SCHEDULED
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
N
N
1000626126191
6/15/2019
6/15/2020
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
X
BODILY INJURY (Per person)
$ XXXXXXX
BODILY INJURY (Per accident
$ XX'XY,,_XXX'
PROPERTY DAMAGE
Per accident
$XXXXXXX
$XXXXXXX
A
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
N
N
1000336580191
6/15/2019
6/15/2020
EACH OCCURRENCE
$ 10,000,000
X
AGGREGATE
$ 10,000,000
DED RETENTION $0
$ XXXXXXX
13
COMPENSATION
WORKERS AND EMPLOYS' LIABILITY Y / N
OFFICER/MEMBER EXCLUDED? ANY PROPRIETOR/PARTNER/EXECUTIVE N❑
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N / A
N
1000003266-01
6/15/2019
6/15/2020
X STATUTE OER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
1,000,000
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)
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.
15727707
City of Fort Collins
PO BOX 580
Fort Collins CO 80522
F ele 7w*if,T171[:i I O
5 ACORD CORPORATION. All riahts reserved
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