HomeMy WebLinkAboutWASTE MANAGEMENT HOLDINGS INC - INSURANCE CERTIFICATE (3)ACOR"' CERTIFICATE OF LIABILITY INSURANCE
16.� 1 /1/2017
DATE(MM/DDIYYYY)
1 12/7/2015
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 LOCKTON COMPANIES
5847 SAN FELIPE, SUITE 320
HOUSTON TX 77057
866-260-3538
CNACT
NAME"
PHONE FAx
A/C No Ext : A/C No
E-MAIL
ADDRESS:
INSURER AFFORDING COVERAGE
NAIC #
INSURER A: ACE American Insurance Company
22667
INSURED WASTE MANAGEMENT HOLDINGS, INC. & ALL AFFILIATED,
INSURER B : Indemnity Insurance Co of North America
43575
INSURER C : ACE Property & Casualty Insurance Co
20699
1300436 RELATED & SUBSIDIARY COMPANIES INCLUDING:
WM PRODUCT RECOVERY SERVICES, L.L.C.
451 W 69TH STREET
INSURER DACE Fire Underwriters Insurance Company
20702
LOVELAND CO 80537
INSURER E :
INSURER F :
rnv=DArrcc CERTIFICATE NUMBER: 1 ;7F757A REVISION NUMBER: XXXXXXX
vTHIS 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
SUER
WVD
POLICY NUMBER
POLICY EFF
MM/DDIYYYY
POLICY EXP
MM/DD/YYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE � OCCUR
XCU INCLUDED
N
N
fIDOG27403311
1/1/2016
1/I/2017
EACH OCCURRENCE
5000.000
DAMAGE ( RENTED
PREMISESS Ea occurrence
5,000,000
X
MED EXP (Any oneperson)
XXXXXXX
X
ISO FORM CG00010413
PERSONAL & ADV INJURY
$ 5,000,000
GEN'L AGGREGATE LIMIT APPLIES PER.
POLICY JECOT- � LOC
OTHER
GENERAL AGGREGATE
$ 6,000,000
PRODUCTS - COMP/OP AGG
$ 6,000,000
$
A
AUTOMOBILE LIABILITY
X ANY AUTO
NED SCHEDULED
X AUTOS
X HIRED AUTOS fAUUTOSWNED
X MCS-90
N
N
MMT II08866326
1/1/2016
1/1/2017
COaBcideDtSINGLE LIMIT000
BODILY INJURY (Per person)
$ XXXX_XXX
BODILY INJURY (Per accident
$ XXXXXX
X
PROPERTY DAMAGE
Per accident
$ XXXXXXX
$ XXXXXXX
C
X
UMBRELLA LIAR
EXCESS LIAB
NCLAIMS-MADE
OCCUR
N
N
XOO G27929242 001
1/1/2016
1/l/2017
EACH OCCURRENCE
$ 15 000000
AGGREGATE
$ 15 000 000
DED I I RETENTION $
$XXXXXXX
H
A
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, d—ribe under
DESCRIPTION OF OPERATIONS below
N/A
N
WLR C48596769 �OS)
WLR C48596800A & MA)
SCF C48596848 ()
1/1/2016
1/1/2016
1 /1/2016
1/1/2017
l/1/2017ANYPROPMETOR/PARTNER/EXECUTIVE
1/1/201
X STATUTE
E.L. EACH ACCIDENT
$ ,,000,OOO
E.L. DISEASE - EA EMPLOYEE
3,000,000
E.L. DISEASE - POLICY LIMIT
3,000,000
A
EXCESS AUTO
LIABILITY
N
N
XSA H08866314
1/1/2016
I/l/2017
COMBINED SINGLE, LIMIT
$9,000,000
(EACH ACCIDENT)
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CFRTIFICATF 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.
13262526
AUTHORIZED REPRESENTATIVE
CITY OF FORT COLLINS
ATTN: PURCHASING DEPT.
P.O. BOX 580
FORT COLLINS CO 80522
Arnon')c r9n1Arn11
Cc�19RR-9nl4 ACORD CORPORATI - All riahts reserved
The ACORD name and logo are registered marks of ACORD
ACORO' CERTIFICATE OF LIABILITY INSURANCE
f`�— 1 / 1 /2017
DATE(M/201 YYY)
12/72015
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 LOCKTON COMPANIES
5847 SAN FELIPE, SUITE 320
HOUSTON TX 77057
866-260-3538
CONTACT
PHONE FAx
AC No Ext : A/C No
E-MAIL
ADDRESS:
INSURER AFFORDING COVERAGE
NAIC #
INSURER A: ACE American Insurance Company
22667
INSURED WASTE MANAGEMENT HOLDINGS, INC. & ALL AFFILIATED,
INSURER B : Indemnity Insurance Co of North America
43575
INSURER C : ACE Property & Casualty Insurance Co
20699
1300436 RELATED & SUBSIDIARY COMPANIES INCLUDING:
WASTE MANAGEMENT OF NORTHERN COLORADO
500 EAST VINE DRIVE
INSURER D : ACE Fire Underwriters insurance Company
20702
FORT COLLINS CO 80524
INSURER E :
INSURER ER F :
r^ rlw c r"CDTICIrATC All IMRF[7- '1429072 REVISION NUMBER: XXXXXXX
_w V L-LJ v�.� •, .vr„ a.. .. v....r �... -. ..... � .. ..-. - -- -
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.
ILTR
TYPE OF INSURANCE
ADDL
INSD
SUBR
WVD
POLICY NUMBER
POLICY EFF
MM/DD/YYYY
POLICY EXP
MM/DDIYYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE � OCCUR
Y
N
HDOG27403311
1/1/2016
1/1/2017
EACH OCCURRENCE
5000000
PREMISES (ETO a RENTED
)
$ 5,000,000
XCU INCLUDED
X
MED EXP (Any oneperson)
XXXXXXX
X
ISO FORM C000010413
PERSONAL & ADV INJURY
$ 5,000,000
GEN'L AGGREGATE LIMIT APPLIES PER.
GENERAL AGGREGATE
$ 6,000,000
PRODUCTS - COMP/OP AGG
$ 6,000,000
POLICY JERCOT � LOC
$
OTHER
A
AUTOMOBILE LIABILITY
Y
N
MMT H08866326
1/1/2016
1/1/2017
Ea acciidentINDSINGLE LIMIT
$ 1,000,000
BODILY INJURY (Per person)
$ XXX�{XXX
X ANY AUTO
BODILY INJURY (Per accident
$ }{X'3{�{}{xx
X AUTS OWNED SCHEDULED
UTOS
X HIRED AUTOS X NON -OWNED
xx
PROPERTY DAMAGE
$ xxxxxxx
$ XXXXXXX
MCS-90
C
X
UMBRELLA LIAB
OCCUR
Y
N
XOO G27929242 001
1/1/2016
1/1/2017
EACH OCCURRENCE
$ 15 000,000
AGGREGATE
$ 15,000,000
EXCESS LIAB
NCLAIMS-MADE
DED I RETENTION $
$XXxxxxx
B
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
OFFICER/MEMBEREXCLUDED?
(Mandatory in NH)
N/A
N
S)
WLR C4H596769 �CA'
WLR C48596800 & MA )
SCFC48596848()
1/1/2016
1/1/2016
1/1/2016
1/1/2017
1/1/2017AANYPROPRIETOR/PARTNER/EXECUTIVE
I/l/2017
X STATUTE OTH-
E.L. EACH ACCIDENT
$ )000000
E.L. DISEASE - EA EMPLOYEE
3,000 000
E.L. DISEASE - POLICY LIMIT
3,000,000
It yes, describe under
DESCRIPTION OF OPERATIONS below
A
EXCESS AUTO
LIABILITY
Y
N
XSA H08866314
I/l/2016
l/l/2017
COMBINED SINGLE LIMIT
$9,000,000
(EACH ACCIDENT)
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
ADDITIONAL INSURED IN FAVOR OF THE CITY OF FORT COLLINS (COLORADO) (ON ALL POLICIES EXCEPT WORKERS'
COMPENSATION/EL) WHERE REQUIRED BY WRITTEN CONTRACT.
CERTIFICATE HOLUER
UAIVI.CLLAI IVIY
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
3429072
AUTHORIZED REPRESENTATIVE
CITY OF FORT COLLINS
P.O. BOX 580
FT. COLLINS CO 80524
rOr„ AM4
(c)19RR-9n14 ACORD CORPORATIOW All riahts reserved
The ACORD name and logo are registered marks of ACORD