HomeMy WebLinkAboutInsurance Cancelation: JACO Environmental
i
DATE /DD/YYY
ACC>Rn
CERTIFICATE OF LIABILITY INSURANCE 09/22/2015
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:
Applied Risk Services, Inc. (A//.NN ,Ext): (877)234-4420 (AC ,No): (877)234-4421
10825 Old Kill Rd E-MAIL
Omaha, NE 68154 ADDRESS:
PRODUCER
CUSTOMER ID #
(877) 234 -442 ® INSURER(S) AFFORDING COVERAGE NAIC #
INSURED INSURER A: California Insurance Co. 38865
,TACO Environmental, Inc. INSURER B:
dba .TACO Environmental, Inc. INSURER C:
18323 Bothell Everett Hwy - - - -
#220 INSURER D.
Bothell, WA 98012-5246 INSURE
CTL 1273 1074318 INSURE
COVERAGES CERTIFICATE NUMBER: REVISION N
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LIS EL EEN LIED TO THE INSURED INAMID A FO E
PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMEN O Y CONTRACT OR M TH PECT TO
WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. T D BY THE POLICIE CR REI SUB CT TO ALL
-i HE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH PO MAY HAVE BEEN REDUC PA L
INSR ADDL.SUBR POLICY EFF
PO
LTR TYPE OF INSURANCE INSR WVD MM/DD/YYYY LIMITS
GENERAL LIABILITY
O NICE $
COMMERCIAL GENERAL LIABILITY E RENTED
I~ CLAIMS ES (Ea occurrence)
' MADE OCC ED EXP An one e on $ _
PERSONAL &ADV INJURY
G_ENERA_L_ A_GG_R_E_GA_T_E___ _,S__ GEN'LAGGREGAT IT APPL - _ _
I PRODUCTS -COMP/OP AGG $
POLICY P LOC - S -
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
~',ANYAUTO (Ea accident) S
ALL OWNED AUTOS BODILY INJURY (per person) S
SCHEDULED AUTOS BODILY INJURY (Per accident)
PROPERTY DAMAGE
HIRED AUTOS (Per accident) $
r-
NON-OWN TO
$
CC . EACH OCCURRENCE IS
E B S-MADEI 'il AGGREGATES-_- - -
S
UCTI
S
RE $ - S
COMPENSATION X WC STATU- OTH
AN MPLOYERS' LIABILITY Y/N _ -TORY LIMITS ER_--_-__----- . -
'ANYPROPRIETOR/PARTNER/ E.L. EACH ACCIDENT S 1,000,000
A EXECUTIVE OFFICER/MEMBER N N/A 73-877317-02-01 09/15/2015 09/15/2016
EXCLUDED?
(Mandatory in NH) E.L. DISEASE-EA EMPLOYEE $ 1,000,000
If yes, describe under
'SPECIAL PROVISIONS below E.L. DISEASE-POLICY LIMIT $ 1,000,000
i
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach Acord 101, Additional Remarks Schedule, if more space is required)
CERTIFICATE HOLDER CANCELLATION
City of ah aryl SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
90 N. Mountain Avenue EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH
THE POLICY PROVISIONS.
Ashland, OCEZ 97520 /y
AUTHORIZED REPRESENTATIVEC" ~
Attn: Purchasing Rlepresentative g 1 1539
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD T1988-2009 ACORD CORPORATION. All rights reserved.