HomeMy WebLinkAboutUNITED SITE SERVICES OF COLORADO INC - INSURANCE CERTIFICATEoRo® CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDD/YYYY)
11M2/2017
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 CONTACT
Marsh USA Inc. NAME:
----
One Towne Square, Suite 1100 UVC NNo,
Ex _ _ A/c No :
Southfield, MI 48076 EMAIL
Attu: detroit.certrequest@marsh.com ADDRESS:
5212--GAWU-17-18
INSURED
United Site Services of Colorado Inc,
6015 East 58th Avenue
Commerce City, CO 80022
INSURER
A: Safety National Casualty Corp. 115105
B : XL Speciality Insurance Company 37885
C : AIG SoecialN Insurance Comoanv 126883
COVERAGES CERTIFICATE NUMBER: CHI-008823727-01 REVISION NUMBER: 0
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
SUER
POLICY NUMBER
MM/DD YYYY
MML
DD/YYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
GL4057787
11/03/2017
11/03/2018
EACH OCCURRENCE
$ 1,000,000
F-v]
CLAIMS -MADE OCCUR
DAMAGE To RNTE
PREMISES E.Eoccur ante
$ 1,000,000
MED EXP (Any one person)
$ 5,000
_
PERSONAL & ADV INJURY
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER.
GENERAL AGGREGATE
$ 2,000,000
POLICY JE� LOC
-XI$
PRODUCTS - COMP/OP AGG
$ 2,000,000
OTHER:
A
AUTOMOBILE LIABILITY
CAS4047369
11103/2017
11/0312018
MBINED SINGLE LIMIT
Cident)
(EOa acc
$ 1,000,000
BODILY INJURY (Per person)
$
X AUTO
rANY
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
L
X
UMBRELLA LIAB
X
OCCUR
US00076933LI17A
11/03/2017
11/03/2018
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 1,000,000
EXCESS LIAB
CLAIMS -MADE
DED I X I RETENTION $10 000
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANYPROPRIETOR/PARTNER/EXECUTIVE Y / N
OFFICER/MEMBER EXCLUDED? —
(Mandatory in NH)
NIA
LDS4047370
11/0312018
X PER OTH-
STATUTE ER
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
C
Pollution
PLC 16214946
08/19/2015
08/19/2018
Each Pollution Incident
1,000,000
Aggregate
1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
City of Fort Collins
Attn: Kevin Williams
215 North Mason Street, 2nd Floor
Fort Collins, CO 80524
Y-11"-1.401 WINPI IL
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
of Marsh USA Inc.
John C Hurleys�
@ 1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD