Loading...
HomeMy WebLinkAbout551459 LT ENVIRONMENTAL INC - INSURANCE CERTIFICATELTENVIR-01 SEGRESTAM 1441cOA 0 `66.� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 7/9/2015 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 Willis of Colorado, Inc. c/o 26 Century Blvd P.O. Box 305191 CONTACT NAME: Willis Global Certificate Center PHONE FAX A/C No Ext : (877 ) 945-7378 (AC,No): (888) 467-2378 E-MAIL s: Certificates@willis.com Nashville, TN 37230-5191 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Arch Specialty Insurance Company 21199 INSURED INSURER B : Travelers Property Casualty Company of America 25674 INSURER C : Pinnacol Assurance Company 41190 LT Environmental, Inc. INSURER D : 4600 W. 60th Ave. Arvada, CO 80003 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. I�jR TYPE OF INSURANCE ADDLNSD WVD POLICY NUMBER MM/DDSUBR YNYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE [)� OCCUR X 12 EMP4345210 07/01/2015 07/01/2016 DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 GEN'L POLICY JET LOC PRODUCTS - COMPIOP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY (CEO MBINED accidentSINGLE LIMIT $ 1,000,000 B X ANY AUTO X DT-810-3A906345-TIL-15 07/01/2015 07/01/2016 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accdent) $ NON -OWNED HIRED AUTOS AUTOS PerOaecldentDAMAGE $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A X EXCESS LIAB CLAIMS -MADE 12 EMX 43817 08 07/01/2015 07/01/2016 AGGREGATE $ 5,000,000 DED RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE FY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N/A 4023969 07/01/2015 07/01/2016 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) Insurer A - Arch Insurance Co. Contractor's Pollution Liability - 12 EMP4345209 - Limit of $1,000,000 Per Occurrence Professional Liability - 12 EMP4345209 - Limit of $1,000,000 Per Occurrence Mold Liability (Claims Made basis) - 12EMP4345209 - $1,000,000 per Claim Combined Aggregate Limit (Pollution - Professional - Mold) - 12EMP 4345209 - Limit of $2,000,000 Aggregate Job Title: Senior Buyer SEE ATTACHED ACORD 101 City of Fort Collins 215 N. Mason Street, 2nd Floor PO Box 580 FION 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 ACORO AGENCY CUSTOMER ID: LTENVIR-01 LOC #: 0 ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED Willis of Colorado, Inc. LT Environmental, Inc. 4600 W. 60th Ave. POLICY NUMBER Arvada, CO 80003 EE PAGE 1 CARRIER NAIC CODE EE PAGE 1 SEE P 1 EFFECTIVE DATE: SEE PAGE 1 AUUI I IUNAL KLMAKKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance SEGRESTAM Page 1 of 1 Description of Operations/Locations/Vehicles: City of Fort Collins is included as an Additional Insured as respects to General Liability and Auto Liability. The underlying schedule on the Excess Liability policy includes the general, contractor's pollution, professional, auto and employer's liability policies. Excess liability policy limits apply to these coverages. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED/ PRIMARY COVERAGE INCLUDING COMPLETED OPERATIONS (COVERAGES A, B, D & F) This endorsement modifies insurance provided under the Environmental Multilane Policy It is agreed that Section III - WHO IS AN INSURED is amended to include the following: Under Coverages A B,D and F the person or organization shown in the schedule below shall be an Additional Insured, but only to the extent liability arises out of YOUR WORK for that Additional Insured and not due to any actual or alleged Independent liability of said Additional Insured. This Endorsement does not apply to BODILY INJURY or PROPERTY DAMAGE arising cut of the sole negligence or willful conduct of, or for defects in design furnished by the Additional Insured. With respect to the coverage afforded to the Additional Insured, this insurance is primary and non- contributory, and our obligations are not affected by any other insurance carried by such Additional Insured whether primary, excess, contingent or on any other basis. This Endorsement does not increase the Company's limits of liability as specified in the Declarations of this policy. Additional insured: ANY PERSON OR ORGANIZATION FOR WHOM YOU PERFORM WORK UNDER A WRITTEN I CONTRACT THAT REQUIRES YOU TO OBTAIN THIS AGREEMENT FROM US. THE WRITTEN CONTRACT MUST BE EFFECTIVE PRIOR TO THE DATE OF THE LOSS OCCURRENCE. All other terns and conditions of this Policy remain unchanged. Endorsement Number:14 Policy Number: 12 EMP 43452 10 Named Insured: L.T. ENVIRONMENTAL, INC. This endorsement is effective on the inception date of this Policy unless otherwise stated herein: Endorsement Effective Date: 07/01/2015 00 EMP0101 00 01 14 1 of 1