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HomeMy WebLinkAbout109244 WASTE MANAGEMENT OF NORTHERN COLORADO - INSURANCE CERTIFICATE (4)AcoRo CERTIFICATE OF LIABILITY INSURANCE 1/1/2019
DATE(MM/DD/YYYY)
12/ 11 /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 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 LOCKTON COMPANIES
3657 BRIARPARK DRIVE, SUITE 700
HOUSTON TX 77042
866-260-3538
CONTACT
NAME:
PHONE FA
A/C, No, Ext : A/C, No
E-MAIL
ADDRESS:
INSURERS AFFORDING COVERAGE
NAIC #
INSURER A: ACE American Insurance COm ar1V
22667
INSURED WASTE MANAGEMENT HOLDINGS, INC. & ALL AFFILIATED,
1300436 RELATED & SUBSIDIARY COMPANIES INCLUDING:
WM PRODUCT RECOVERY SERVICES, L.L.C.
451 W 69TH STREET
LOVELAND CO 80537
INSURER B : Indemnity Insurance Co of North America
43575
INSURER C : ACE Fire Underwriters Insurance Company
20702
INSURER D
INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER: 13262526 REVISION NUMBER: XXXXXXX
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
LTR
TYPE OF INSURANCE
ADDL
INSD
SUBR
WVD
POLICY NUMBER
POLICY EFF
MM/DD/YYYY
POLICY EXP
MM/DD/YYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE � OCCUR
XCU INCLUDED
N
N
HDO G27873091
1/1/2018
1/1/2019
EACH OCCURRENCE
5,000,000
DAMAGE TO RENTED
PREMISES Ea occurrence
5,000,000
X
MED EXP (Any oneperson)
XXXXXXX
X
ISO FORM CG00010413
PERSONAL & ADV INJURY
$ 5,000,000
GENT AGGREGATE LIMIT APPLIES PER:
POLICY PE FILOC
OTHER
GENERAL AGGREGATE
$ 6,000,000
PRODUCTS - COMP/OP AGG
$ 6,000,000
1
$
A
AUTOMOBILE LIABILITY
X ANY AUTO
X OOWNEDONLY SCHEDULED
AUTOSAUTOS
X AUTOS ONLY X NON-OWNED
ONLY
X MCS-90
N
N
MMT H25097890
1/1/2018
1/1/2019
SINGLE LIMIT
Ea accident)
$ 1 000 000
BODILY INJURY (Per person)
$ XXXXXXX
BODILY INJURY (Per accident
$ XX'}�}{xxx
(PerPROPERTY
a cede DAMAGE
$ XXXXXXx
$ XXXXXXX
A
X
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
N
N
XOO G27929242 003
1/1/2018
1/1/2019
EACH OCCURRENCE
$ 15,000,000
AGGREGATE
$ 15,000,000
DED I I RETENTION $
$ XXXXXXX
B
A
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE YIN
OFFICER/MEMeEREXCLUDED?
(Mandatory in NH)
if yes, dsscrLe ur.Car
DESCRIPTION OF OPERATIONS below
N/A
N
WLR C6462278A (AOS)
WLR C64622778(AAZ,CA,&MA
SCF C64622791 (WI)
1/1/2018
1/1/2018
1/1/2018
1/1/2019
1/1/2019
1/1/2019
PER OTH-
X STATUTE ER
E.L EACH ACCIDENT
$ 3000,000
E.L. DISEASE - EA EMPLOYEE
3, 000,000
E.L. DISEASE - POLICY LIMIT
3,000,000
A
EXCESS AUTO
LIABILITY
N
N
XSA H25097889
1/1/2018
1/1/2019
COMBINED SINGLE LIMIT
$9,000,000
(EACH ACCIDENT)
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CERTIFICATE HOLDER CANCELLATION
13262526
CITY OF FORT COLLINS
ATTN: PURCHASING DEPT.
P.O. BOX 580
FORT COLLINS CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
A(-r)Pr) 9S /gn1R/n'z1
Cc)1QRR_9n18 ACnRr) rORPORATI(7M All rinhts rpsprvpri
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