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HomeMy WebLinkAbout468473 VEOLIA ES TECHNICAL SOLUTIONS LLC - INSURANCE CERTIFICATE (10)SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME: CONTACT (A/C, No): FAX E-MAIL ADDRESS: PRODUCER (A/C, No, Ext): PHONE INSURED COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ PROPERTY DAMAGE $ BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOS ONLY AUTOS NON-OWNED OWNED SCHEDULED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: Expiration Date: 01/01/2021� 2 2 � Limit: SEE ABOVE � Chicago Policy Number: WC 046-91-2805 (MA, ND, OH, WA, WI, WY)� Carrier: Insurance Company of the State of Pennsylvania� Expiration Date: 01/01/2021� Effective Date: 01/01/2020� �� �� � Workers Compensation (Cont.)� Certificate of Liability Insurance CN102584993 Carrier: American Home Assurance (NAIC # 19380)� Effective Date: 01/01/2020� Limit: SEE ABOVE�� Marsh USA, Inc.� 9131 East 96th Avenue� Veolia ES Technical Solutions, LLC� Henderson, CO 80640 25 Policy Number: WC 046-91-2806 (CA)� (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT ER OTH- STATUTE PER (MM/DD/YYYY) LIMITS POLICY EXP (MM/DD/YYYY) POLICY EFF LTR TYPE OF INSURANCE POLICY NUMBER INSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB EACH OCCURRENCE $ AGGREGATE $ $ OCCUR CLAIMS-MADE DED RETENTION $ PRODUCTS - COMP/OP AGG $ GENERAL AGGREGATE $ PERSONAL & ADV INJURY $ MED EXP (Any one person) $ EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY E 1,000,000 01/01/2021 GL5425835 Manashi Mukherjee NJ, PA, UT, VA, VT) CHI-008065640-57 1,000,000 WC 046-91-2803 (AZ, IL, KY, NC, NH, X 01/01/2020 SIR $750,000 Aggregate of Marsh USA Inc. Attn: Veolia.CertRequest@marsh.com | Fax: 212-948-5053 N 01/01/2020 01/01/2020 X Illinois National Insurance Company A 01/01/2021 01/01/2020 A 01/01/2021 CA9767418 (AOS) Pollution Legal Liability B 1,000,000 1,000,000 WC 046-91-2804 (FL) N/A New Hampshire Insurance 1,000,000 X D X 12/16/2019 HEN-TS 1,000,000 01/01/2020 1,000,000 City of Fort Collins, its officers, agents and employees are included as additional insured where required by written contract but only for liability arising out of the operations of the named insured with respect to General Liability and Auto Liability. X 01/01/2021 01/01/2020 Attn: Ed Bonnette, CPM 215 North Mason City of Fort Collins Lloyd’s Syndicates 623/2623 P.O. Box 580 CA9767420 (VA) A N/A Per Claim 10,000 01/01/2021 1,000,000 01/01/2021 Claims Made Form B CA9767419 (MA) 1,000,000 19445 1,000,000 1,000,000 01/01/2021 WC 046-91-2802 (AOS) 540 W. Madison Street Marsh USA, Inc. Chicago, IL 60661 9131 East 96th Avenue Veolia ES Technical Solutions, LLC Henderson, CO 80640 W1D4C8200401 01/01/2020 Purchasing Division Fort Collins, CO 80522 01/01/2020 A 01/01/2021 23817 National Union Fire Insurance Company Of Pittsburgh,