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HomeMy WebLinkAbout330448 JACO ENVIRONMENTAL - INSURANCE CERTIFICATE (14)JACOENV-01 BMILLER ACORO CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDlYYYY)9/21/2015 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 Hub International Northwest LLC 12100 NE 195th St. Suite 200 CONTACT NAME: PHONE (425) 489-4500 AX No): (425) 485-8489 A!C Ext IL A DRESS: now.info@hubinternational.com Bothell, WA 98011 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Starr Surplus Lines Insurance Company 13604 INSURED INSURER B : INSURER C : JACO Environmental, Inc. INSURER D : 18323 Bothell -Everett Hwy #220 INSURER E : Bothell, WA 98012 INSURER F : COVFRAGFS 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DDYM�YVEFF EXP MM/DDYlYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE J OCCUR L 1000065905151 09/15/2015 09115I2016 TED PREMISES Ea occurrence $ 50,000 X INCL STOP GAP LIAB MED EXP (Any one person) $ 5,000 X $10,000DEDUCTIBLE PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY JECT PRO X]LOC $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 X AGGREGATE $ 5,000,000 A EXCESS LIAB CLAIMS -MADE 1000336706151 09/15/2015 09/15/2016 DED RETENTION $ 0 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE PER OTH- STATUTE ER �ELEACH ACCIDENT $ j E.L. DISEASE - EA EMPLOYEEI $ OFFICERIMEMBER EXCLUDED? ❑ (Mandatory in NH) N / A E.L. DISEASE - POLICY LIMIT 1 $ If yes, descnbe under DESCRIPTION OF OPERATIONS below, A SITE POLLUTION 1000065905151 09/15/2015 09/15/2016 EACH CLAIM 1,000,000 A SITE POLLUTION 1000065905151 09/15/2015 09/15/2016 (AGGREGATE 5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Excess Liability extends over General Liability, Auto Liability, Pollution Liability, and Professional Liability. CFRTIFICATF HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Purchasing Division Attn: Christine Patterson -Jarvis AUTHORIZED REPRESENTATIVE 444 700 Wood Street Fort Collins, CO 80522-0580 ACORD 25 (2014/01) @ 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AC"R© CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYV) `11, 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). I PRODUCER CONTACT NAME: PHONE FAX Applied Risk Services, Inc. (A/C,No,Ext): 771234-4420 (A/C,No): (g77)23d_4d21 10825 Old Mill Rd E-MAIL Omaha, NE 68154 ADDRESS: PRODUCER j CUSTOMER ID # (8 7 7) 2 3 4- 4 4 2 0 INSURER(S) AFFORDING COVERAGE NAIC / INSURED INSURER A: I I JAM Environmental, Inc. INSURERB. dba JACO Environmental, Inc. INSURERC: 18323 Bothell Everett Hwy INSURER D: j #220 -- --- Bothell, WA 98012-5246 INSURERE: CTL 1273 1074296 INSURERF: nnvconr_cc r`1=DTl1=l1 ATC nu InADCD• RFVISInN NIIMRFR• 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 ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/D MM/D LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES Ea=urtence COMMERCIAL GENERAL LIABILITY CLAIMS ❑ ❑ $ MED EXP An one n $ MADE OCCUR PERSONAL & ADV INJURY $ — GENERAL AGGREGATE $ - GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY PROJECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO ❑ ❑ (Ea accident) $ BODILY INJURY(Per rson $ ALL OWNED AUTOS BODILY INJURY Per accident) $ SCHEDULED AUTOS DAMAGE HIRED AUTOS (Per accident) $ $ NON -OWNED AUTOS UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE ❑ ❑ DEDUCTIBLE $ $ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/ EXECUTIVE OFFICER/MEMBER EXCLUDED? i N/A ❑ 3 - 87 7 317 - 0 2 - 02 99/15/2015 /15/2016 WC STATU- OTH- ORY LIMIT E.L. EACH ACCIDENT $ (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $1,000,000 E.L. DISEASE -POLICY LIMIT $ If yes, describe under SPECIAL PROVISIONS below n �J DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach Acord 101, Additional Remarks Schedule, if more space is required) /`CDTICI!`ATP unI nFL7 f'ANCFI I ATInKI City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH Purchasing Divisim THE POLICY PROVISIONS. 700 good St Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE {4� Attn: Christine Patterson -Jarvis- N P A 0 01 1 0 8 4 ACORD 25 (2009/09) The ACUHU name ano logo are registered marKS Or ACUKU ()T9U0-Zuua AwnU 1.,UH VUr1Ar iUN. An rignrs reserves.