Loading...
HomeMy WebLinkAbout304997 BELFOR ENVIRONMENTAL - INSURANCE CERTIFICATE (3)�1 ® AFRO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/29/2018 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: (A/C- No. Ext): (866) 283-7122 (AA/C. No.): (800) 363-0105 E-MAIL ADDRESS: 3000 Town Center Suite 3000 Southfield Mi 48075 USA INSURER(S) AFFORDING COVERAGE NAIC # 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 INSURERC: American Home Assurance Co. 19380 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570072080408 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 ILTR TYPE OF INSURANCE NSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY GL 1 1 2019 EACH OCCURRENCE $ 2 , 000 , 000 CLAIMS -MADE OCCUR AOS (SIR) SIR applies per policy terns & conditions DAMAGE TO RENTED PREMISES Ea occurrence) $2,000, 000 MED EXP (Any one person) $10, 000 A GL7468787 07/01/2018 07/01/2019 NY (Deductible) PERSONAL &ADV INJURY $2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $4,000,000 POLICY F7] PRO FX] LOC JECT PRODUCTS - COMP/OPAGG $4,000,000 OTHER: • AUTOMOBILE LIABILITY CA 4288091 ADS 07/01/2018 07/01/2019 COMBINED SINGLE LIMIT Ea accident $2 , 000 , 000 BODILY INJURY ( Per person) A X ANYAUTO CA 4288092 07/01/2018 07/01/2019 BODILY INJURY (Per accident) OWNED SCHEDULED MA A AUTOS ONLY AUTOS CA 4288093 07/01/2018 07/01/2019 PROPERTY DAMAGE HIREDAUTOS NON -OWNED ONLY AUTOS ONLY VA Per accident LLABOCCUR EACH OCCURRENCE AGGREGATE 4EDMBRELLA XCESS LIAB CLAIMS -MADE RETENTION B B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE YIN OFFICER/MEMBEREXCLUDED? (Mandatory in NH) N/A wc014629590 ADS WC014629591 FL 07/01/2018 07/01/2018 07/01/2019 07/01/2019 X STATUTE OTH IER 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 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 580 Fort Collins Co 80522 USA p 0 c m 0 0 0 rn O Z d i4 U 0) U ©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 #: ADDITIONAL REMARKS SCHEDULE Page _ of AGENCY Aon Risk Services Central, Inc. NAMEDINSURED Belfor Environmental, Inc. POLICY NUMBER see Certificate Number: 570072080408 CARRIER See Certificate Number: 570072080408 NAIC CODE EFFECTIVE DATE. ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liabilitv 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 SUBR \VVD POLICY NUMBER POLICY EFFECTIVE DATE MMIDDIYYYV) POLICY EXPIRATION DATE (MM/DD/YYYY LIMITS WORKERS COMPENSATION B **Also includes N/A wc014629592 MA, NO, OH, WA, WI, WY 07/01/2018 07/01/2019 C Az, NJ, PA, & VA** N/A wc014629593 CA 07/01/2018 07/01/2019 g N/A wc014629594 *"IL, KY, NC, NH, UT** 07/01/2018 07/01/2019 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD