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HomeMy WebLinkAboutBELFOR ENVIRONMENTAL - INSURANCE CERTIFICATEAFRO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 02/06,2018 I 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 AOn Risk Services Central, Inc. Southfield MI Office CONTACT NAME: PHONE/N. Ext): (866) 283-7122 (�C (800) 363-0105 E-MAIL ADDRESS: 3000 Town Center suite 3000 INSURER(S) AFFORDING COVERAGE NAIC # Southfield MI 48075 USA INSURED INSURER A: National union Fire Ins Co of Pittsburgh 19445 Belfor Environmental, Inc. INSURER B: The Insurance Co of the State of PA 19429 5075 Kalamath Street Denver CO 80221 USA Denver INSURERC: American Home Assurance Co. 19380 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570070145573 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. Limits shown are as requested LTR TYPE OF INSURANCE NSD WVD POLICY NUMBER MM1DD/YYYY MWDDfYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY GL 4 EACH OCCURRENCE $2,000,000 CLAIMS -MADE X❑ OCCUR AOS (SIR) SIR applies per policy terns & conditions DAMAGE TRENTED PREMISES Ea occurrence $2,000,000 MED EXP (Any one person) $10 , 000 A GL7468703 07/01/2017 07/01/2018 NY (Deductible) PERSONAL &ADV INJURY $2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $4, 000, 000 POLICY [E] PRO a LOC JECT PRODUCTS - COMP/OP AGG $4,000,000 OTHER: A AUTOMOBILE LIABILITY CA 3194557 ADS 07/01/2017 07/01/2018 COMBINED SINGLE LIMIT Ea accident $2,000,000 BODILY INJURY ( Per person) A X ANYAUTO CA 3194558 07/01/2017 07/01/2018 BODILY INJURY (Per accident) A OWNED SCHEDULED x AUTOS ONLY AUTOS X HIREDAUTOS NON -OWNED ONLY AUTOS ONLY MA CA 3194559 VA 07/01/2017 07/01/2018 PROPERTY DAMAGE Per accident UMBRELLA LIAR EACH OCCURRENCE AGGREGATE EXCESS LIAB HOCCUR CLAIMS -MADE DED RETENTION B B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/ PARTNER I EXECUTIVE YIN OFFICER/MEMBEREXCLUDED? (Mandatory in NH) NIA wc014629466 ADS WC014611467 FL 07/01/2017 07/01/2017 07/01/2018 07/01/2018 X SPERTATUTE ORH E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1 , 000 , 000 If yes, describe under DESCRIPTiON OF OPERATIONS below FI DISEASE -POLICY LIMIT $1 , 000 , 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins, its officers, agents and employees are included as Additional Insured in accordance with the policy provisions of the General Liability and Automobile Liability policies. Should General Liability, Automobile Liability and workers' Compensation policies be cancelled before the expiration date thereof, the policy provisions will govern how notice of cancellation may be delivered to certificate holders in accordance with the policy provisions. 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. City Of Fort Collins AUTHORIZED REPRESENTATIVE Attn: Purchasing Director Po Box 580i `jC cJsfititit�M (`sG eJna Fort Collins CO 80522 USA `m ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000005415 LOC #: ,4 ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY Aon Risk Services Central, Inc. NAMEDINSURED Belfor Environmental, Inc. POLICY NUMBER see Certificate Number: 570070145573 CARRIER See Certificate Number: 570070145573 NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSR LTR TYPE OF INSURANCE ADDL iNSD SCBR wYn POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YYYY POLICY EXPIRATION DATE MM/DD/YY LINIIIS WORKERS COMPENSATION B **Also includes N/A WC014629468 MA, ND, OH, WA, WI, WY 07/01/2017 07/01/2018 C AZ, NJ, PA, & VA** N/A wc014629469 CA 07/01/2017 07/01/2018 B N/A wc014629470 **IL, KY, NC, NH, UT** 07/01/2017 07/01/2018 ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD