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HomeMy WebLinkAboutInsurance Certificate: JACO Environmental Inc °RO® CERTIFICATE OF LIABILITY INSURANCE page 1 of 2 09/1 /D20 4 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: Willis of Seattle, Inc. PHONE FAX c/o 26 Century Blvd. A/C NO EXT: 877-945-7378 A/C No: 888-467-2378 P. O. Box 305191 ADESS: certificates@willis.com DRI Nashville, TN 37230-5191 INSURER(S)AFFORDINGOOVERAGE NAIC # INSURERA: Aspen specialty insurance Company 10717-001 INSURED JACO Environmental, Inc INSURER B: St. Paul Surplus Lines Insurance Co. 30481-000 . PO Box 14307 INSURERC:California Insurance Company 38865-001 Mill Creek, WA 98082 INSURER D: Continental Indemnity Company 28258-001 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 22072379 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 DD' SUB POLICY EFF POLICY EXP T TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDD/YYYYI M DD VV LIMITS A GENERAL LIABILITY ERAAK1414 9/15/2014 9/15/2015 EACHOCCURRENCE $ 2,000,000 1AMAG X COMMERCIAL GENERAL LIABILITY PREMI ETORENTED PREMISES Eaoccurence $ 1,000,000 CLAIMS-MADE OCCUR MED EXP (Anyone person) $ 5 000 X WA Stop Gap Included PERSONAL BADVINJURY $ 2,000,000 X $10,000 Deductible GENERALAGGREGATE $ 2 000 000 GENI AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 2,000,000 17 POLICY X PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIREDAUTOS HNON-OWNED P OPERentDAMA E $ AUTOS B X UMBRELLA LIAB XJ OCCUR ZUP14S7979814F 9/15/2014 9/15/2015 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED X RETENTION$ 10,000 $ C WORKERS COMPENSATION 738773170102 9/15/2014 9/15/2015 X TNRY AND EMPLOYERS' LIABILITY LIM T ER D ANY PROPRIETOR/PARTNER/EXECUTIVEVâť‘ N/A 738773170104 9/15/2014 9/15/2015 E.L. EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? (Mandatory, in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 f yes, describe under 0 0 0 0 0 0 DESCRIPTION OF OPERATIONS below E. L. DISEASE -POLICY LIMIT $ 1, , A ERAAK1414 9/15/2014 9/15/2015 Pollution Legal Liability $2,000,000 Per Incident including BI/PD & Cleanup $2,000,000 Aggregate Policy # ERAAK1413 $ 25,000 Deductible Each Incident DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (Attach Acord 101, Additional Remarks Schedule, if more space is required) Workers Compensation Policy #73-877317-01-04: Covers the following states: Covers: AZ, CA, GA, NV, OR, TX, UT. Workers Compensation Policy #73-877317-01-02: Covers the following states: IL, IN, MD, MI, MN, NC, NJ, NM, PA. 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 EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland AUTHORIZED REPRESENTATIVE Attn: Purchasing Representative 90 N. Mountain Avenue Ashland, OR 97520 Coll:4517918 Tpl:1862738 Cert:22072379 0 1988-2010ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: JAC088 LOC#: ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED JACO Environmental, Inc. Willis of Seattle, Inc. PO Box 14307 POLICY NUMBER Mill Creek, WA 98082 See First Page CARRIER NAIC CODE See First Page EFFECTIVEDATE: See First Page ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Excess Pollution Legal Liability Policy # EXAD93M14 Effective Date: 09/15/2014 Expiration Date: 09/15/2015 Insurance Carrier: Aspen Specialty Insurance Company Limits: $3,000,000 ACORD 101 (2008/01) Coll:4517918 Tpl:1862738 Cert:22072379 ©2008ACORDCORPORATION. Allrights reserved. The ACORD name and logo are registered marks of ACORD