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HomeMy WebLinkAbout109244 WASTE MANAGEMENT OF NORTHERN COLORADO - INSURANCE CERTIFICATE (5)ACORU° CERTIFICATE OF LIABILITY INSURANCE
1/1/2019
DATE(MM/DD/YYYY)
12/ 1 1 /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
NAME:
A/c, PHONENo, Ext : FAX
A/C, No
E-MAIL
ADDRESS:
INSURERS AFFORDING COVERAGE
NAIC #
INSURER A : ACE American Insurance Company
22667
INSURED WASTE MANAGEMENT HOLDINGS, INC. & ALL AFFILIATED,
1300299 RELATED & SUBSIDIARY COMPANIES INCLUDING:
WASTE MANAGEMENT OF ARIZONA, INC.
222 S MILL AVE, SUITE 333
TEMPE AZ 85282
INSURER B : Indemnity Insurance Co of North America
43575
INSURER C : ACE Fire Underwriters Insurance Company
20702
INSURER D :
INSURER E :
INSURER F :
rAVFRAr;FC A7PI40POI rFRTIFF IrATNIIMRFR• 149dR,06 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
T
TYPE OF INSURANCE
ADDL
INSD
SUER
WVD
POLICY NUMBER
POLICY EFF
M/DD/YYYY
POLICY EXP
M /
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE FRI OCCUR
Y
Y
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
XCU INCLUDED
X
ISO FORM CG00010413
PERSONAL & ADV INJURY
$ 5,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 6,000,000
]POLICYa JECOT FLOC
PRODUCTS - COMP/OP AGG
$ 6,000,000
1
$
OTHER:
A
AUTOMOBILE LIABILITY
Y
Y
MMT H25097890
1/1/2018
1/1/2019
(CEO, eBlcdeDiSINGLE LIMIT
$ 1,000, 000
BODILY INJURY (Per person)
$ XXXXXXX
ANY AUTO
OWNED SCHEDULED
ONLY AUTOS
AUTOS ONLY X AUOTOS ONLDY
1xx
BODILY INJURY (Per accident
$ XXXXXXXAUTOS
Pe�acadenDAMAGE$XXXXXXX
$ XXXXXXX
MCS-90
A
UMBRELLA LIAB
X
OCCUR
Y
Y
XOO G27929242 003
1 i 1 /2018
1/1/2019
EACH OCCURRENCE
$ 15,000,000
I
AGGREGATE
$ 15,000,000
EXCESS LIAB
CLAIMS -MADE
DED RETENTION $
$XXXXXXX
B
A
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE YIN
OFFICER/MEMBER EXCLUDED? N❑
(Mandatory in NH)
N/A
Y
WLR C6462278A (AOS)
WLR C64622778 ((AZ,CA,&MA
SCFC64622791 (WI)
1/1/2018
1/1/2018
1/1/2018
1/1/2019
1/1/2019
1/1/20I
PER
X STATUTE ER
E.L. EACH ACCIDENT
$ 3,000,000
E.L. DISEASE • EA EMPLOYEE
3,000,000
If yes, describe under
DES^_R!PT!ON OF OPERP.T!ONS be!a
.L. DISEASE -POLICY LIMIT
- 3,000,000
A
1EXCESSAUTO
LIABILITY
Y
Y
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)
BLANKET WAIVER OF SUBROGATION IS GRANTED IN FAVOR OF CERTIFICATE HOLDER ON ALL POLICIES WHERE AND TO THE EXTENT
BY WRITTEN CONTRACT WHERE PERMISSIBLE CERTIFICATE HOLDERAS ANINSURED
(EXCEPT OR WORKERS' COMP/ELWHERE AND TO THE EXTENT REQUIRED BY WRITTEN CONTRACT. ADDITIONLINSURDINAVOR
CF
OF THE CITY, ITS OFFICERS, AGENTS AND EMPLOYEES ON ALL POLICIES (EXCEPT WORKERS' COMPENSATION/EL) WHERE AND TO THE
EXTENT REQUIRED BY WRITTEN CONTRACT.
l IZM 1 IF 1\. IC
If E P111*1I11
PURCHASING DIRECTOR
CITY OF FORT COLLINS
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
Arnan it rinia/nz►
Cc�19RR-2015 ACORD CORPORATION- All riahts reserved
The ACORD name and logo are registered marks of ACORD
CONTINUATION DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS (Use only if more space is required)
ALL POLICIES INCLUDE A BLANKET NOTICE OF CANCELLATION TO CERTIFICATE HOLDERS
ENDORSEMENT, PROVIDING FOR 30 DAYS' ADVANCE NOTICE IF THE POLICY IS CANCELLED BY
THE COMPANY OTHER THAN FOR NONPAYMENT OF PREMIUM, 10 DAYS' NOTICE IF THE POLICY IS
CANCELLED FOR NONPAYMENT OF PREMIUM. NOTICE IS SENT TO CERTIFICATE HOLDERS WITH
MAILING ADDRESSES ON FILE WITH THE AGENT OR THE COMPANY. THE ENDORSEMENT DOES NOT
PROVIDE FOR NOTICE OF CANCELLATION IF THE NAMED INSURED REQUESTS CANCELLATION.
ACORD 25 (2016/03) Certificate Holder ID: 14948306