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HomeMy WebLinkAboutBENSON ROLL-OFF SERVICES LLC - INSURANCE CERTIFICATE (7)BENSO-1 OP ID: JD ACORO' DATE (MM/DD/YYYY) `,.,f CERTIFICATE OF LIABILITY INSURANCE F10/26/2017 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 CONTANAME: Jody Wagner Brown &Brown Inc PHONE 970-494-4672 FAX 4532 Boardwalk Dr, Suite 200 Alc No Exe : A/c No): 970-484-4165 Fort Collins, CO 80525 E-MAIL ner bbcolorado.com William S. Rich ADDRESS: jwa 9 INSURED Benson Roll -Off Services, LLC 6885 Lowell Blvd. Denver, CO 80221 INSURER A: Firemens Ins Comp of WA, DC INSURER B: Argonaut Insurance Company INSURER C INSURER D INSURER E : INSURER F : rr1VFRAnFR rFRTIFICATF NIIMRFP- RFVISION NLIMRFR- 19801 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. POLICY EXP INSR TYPE OF INSURANCE POLICY NUMBER MMLDDIYYYYICY MM/DDIYI'YY LIMITS LTR A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X1 OCCUR CPA314642220 10/2312016 11/07/2017 EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 15,000 PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY � JE LOC OTHER: GENERAL AGGREGATE $ 2,000,00 PRODUCTS -COMP/OP AGG $ 2,000,00 _ _ $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS CPA314642220 10/23/2016 11/07/2017 COMBINED SINGLE LIMIT Ea accident $ 1,000,00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ A X UMBRELLA LAB EXCESS LAB X OCCUR CLAIMS -MADE CPA314642220 10/23/2016 11/07/2017 EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,00 DIED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WC928218472974 12/01/2016 12/01/2017 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEd $ 1,000,00 E.L. DISEASE -POLICY LIMIT 1 $ 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) rFRTIFIrATF IJrll r1FR rANrFI I ATInN CITYFC2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 580 AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD BENSO-1 PAGE 2 NOTEPAD INSURED'S NAME Benson Roll -Off Services, LLC OP ID: JD Date 10126/2017 If required by written contract, the following blanket endorsements apply: General Liability: CLCGO059 (09/16) Contractors' Enhancement Endorsement including Additional Insured -Owners, Lessees or Contractors -Ongoing Operations Additional Insured -State or Governmental Agency Additional Insured -Lessor of Leased Equipment Waiver of Transfer of Rights or Recoverry Against Others CG2001-Primary-NonContributory for Additional Insureds CLCG2062 (09/16) Additional Insured -Owners, Lessees or Contractors - Completed Operations Auto Liability: CW3468 (02/15) Expansion Endorsement-Platimum including Additional Insured by Contract or Agreement Waiver of Subrogation by Contract or Agreement kers Compensation: 99313 (04-84) Blanket Waiver of Subrogation