HomeMy WebLinkAboutInsurance Certificate: JACO Environmental Inc ''�°'ZO® CERTIFICATE OF LIABILITY INSURANCE page 1 of 1 09/`1/0 2
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 CONTACT
NAME
Willie of Seattle, Inc. PHONE FAX
c/o 26 Century Blvd. pvc.No.ExTi 877-945-7378 MIC NO): 888-467-2378
P. O. Box 305191 UDAWss Certificatee®willis.COm
Nashville, IN 37230-5191
I NSUR ER(S)AFFORDING COVERAGE NAICs
INSURERA: Aspen Specialty Insurance Company 10717-001
INSURED JACD Environmental, Inc. INSURERS: St. Paul Surplus Lines Insurance Co. 30481-000
PO Box 14307 INSURERC: Zurich American Insurance Company 16535-001
Nil, Creek, NA 98082
INSURER D:
- INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 18547786 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.
INSR TYPE OFINSURANCE OD' SUB POLICY NUMBER POLICY EFF POLICY EXP LIMITS N= wvD
A GENERAL LIABILITY ERAAK1412 9/15/2012 9/15/2013 EACHOCCURRENCE $ 2,000,000
ANA X COMMERCIAL GENERAL LIABILITY PREMISES EsEOCCUnmor $ 1 000,QOO
CLAIMS-MADEY OCCUR NED EXP(My one person) $ 5,000
X WA Stop Gan Included PERSONAL B ADV INJURY $ 2,000,000
X $10,000 Deductible GENERAL AGGREGATE $ 2,000,000
GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ 2,000,000
POLICY X PRO LOC $
FMOBILELIABILITY COMBINED SINGLE LIMIT $
ANY AUTO BODILY INJURY(Per person) $
ALLOWNED SCHEDULED BODILY INJURY(Per a=ident) $
HIRED AUTO$ AUTOSWNED (PR UPA ER Won) A $
B X UMBRELLA LIAR N OCCUR ZUP14S7979812NF 9/15/2012 9/15/2013 EACHOCCURRENCE $ 51000,000
EXCESS LIAR CLAIMS-MADE AGGREGATE $ 51000,000
DED I X RETENTION$ 10,000 $
* WORKERS COMPENSATION WC672515802 9/15/2012 9/15/2013 X
AND EMPLOYERS'LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑ N/A EL EACH ACCIDENT $ 1,000,000
OFFICER/MEMBER EXCLUDED?
rnset' in NH) E.L.DISEASE EA EMPLOYEE $ 1,000,000
s,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT Is 1,000,000
A BRAAK1412 9/15/2012 9/15/2013
Pollution Legal Liability $5,000,ODO Per Incident
including HI/PD 6 Cleanup $5,000,ODO Aggregate
$ 25,ODO Deductible Each Incident
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach Aoxd 101,Additonal Remarks Scwule,if more"ce is requires)
The Workers' Compensation policy covers Wisconsin, California, New Mexico, Nevada, Oregon, Utah,
Illinois, Colorado, Idaho, Georgia, Maine, Maryland, Massachusetts, Michigan, New Jersey,
Pennsylvania, Arizona, New York, Texas and Maine only.
The Umbrella policy also extends over the primary Auto Liability policy which has a $2,000,000
limit.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE THEREOF,
CITY RECORDER ACCORDANCE EXPIRATION
POLICY PROVI IONSE WILL BE DELIVERED IN
City of Ashland AUTHORIZED REPRESENTATIVE
Attn: Purchasing Representative
90 N. Mountain Avenue
Ashland, OR 97520
Coll:3861613 Tpl:1516510 Cert:18547786 ®1988-2010 ACORD CORPORATION.All rights reserved.
ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD