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HomeMy WebLinkAboutInsurance Certificate: JACO Enivornmental JACOENV-01 WILLER ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 9/21/2015 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: Hub International Northwest LLC PHONE (425 489-4500 FvC, No): (425) 485-8489 12100 NE 195th St. A/C No Ext : ) Suite 200 ADDRESS: now.info@hubinternational.com Bothell, WA 98011 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Starr Surplus Lines Insurance Company 13604 INSURED INSURER B : JACO Environmental, Inc. INSURER C : 18323 Bothell-Everett Hwy #220 INSURER D : Bothell, WA 98012 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 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. LTR M DDNYYY LIMITS I R TYPE OF INSURANCE ADDL INSD ,S WVD POLICY NUMBER MM/DD/YYYY M LT A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE LX OCCUR 11000065905151 109/15/2015 09/1512016 PREMISES Ea occurrence $ 50,000 X INCL STOP GAP LIAB MED EXP (Any one person) $ 5,000 X $10,000 DEDUCTIBLE PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 LOC PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY 7 JEC T PRO- F 1 OTHER: $ AUTOMOBILE LIABILITY 'i COMBINED SINGLE LIMIT $ Ea accident ANY AUTO li BODILY INJURY (Per person) ! $ ALL OWNED SCHEDULED I,I AUTOS AUTOS BODILY INJURY (Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A X EXCESS LIAB CLAIMS-MADE' 11000336706151 09/15/2015 09/15/2016 AGGREGATE $ 5,000,000 DED RETENTION $ 0 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y / N '.STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N /A (Mandatory in NH)- - E.L. DISEASE - EA EMPLOYEE' $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ A SITE POLLUTION 1000065905151 09/15/2015 09/15/2016 EACH CLAIM 1,000,000 A SITE POLLUTION 11000065905151 09/15/2015 09/15/2016 AGGREGATE 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Excess Liability extends over General Liability, Auto Liability, Pollution Liability, and Professional Liability. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Purchasing Representative 90 N. Mountain Avenue Ashland, OR 97520 AUTHORIZED REPRESENTATIVE 4-1444 0-10~ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD