HomeMy WebLinkAboutInsurance Certificate: JACO Environmental "� CERTIFICATE OF LIABILITY INSURANCE page 1 of 1 09/`1/2011
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. A/C No EXT: 877-945-7378 888-467-2378
P. O. Box 305191 E-MAIL
Nashville, TN 37230-5191
AD RE certificates®willis.com
INSURER(S)AFFORDING COVERAGE NAICp
INSURERA: Zurich American Insurance Company 16535-001
INSURED JACO Environmental, Inc. INSURERB: St. Paul Fire and Marine Insurance Compan 24767-001
PO Box 14307 INSURERC: Steadfast Insurance Company 26387-001
Mill Creek, WA 98082
INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 16527525 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 DD' SUB POLICY NUMBER POLICY EFF POLICY UP LIMITS
A GENERAL LIABILITY GL0672515901 9/15/2011 9/15/2012 EACH OCCURRENCE $ 2,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
PREMISES Ea accuranca $ 1,000,000
CLAIMS-MADE OCCUR MEDEXP(Anyone Ninon) $ 5 000
X WA Stop Gap Included PERSONAL a ADV INJURY $ 11000,000
X $10,000 Deductible GENERALAGGREGATE $ 2.000.000
G EN'L AGGREGATE LIMIT APPLI ES PER PRODUCTS-COMP/OPAGG $ 2,000,000
POLICY X PRO- LOC $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) $
ANYAUTO BODILY INJURY(Perperson) $
ALLOWNED SCHEDULED
AUTOS AUTOS BODILY INJURY(Peracciden0 $
HIREDAUTOS NON-OWNED PF30PERTY DAMAGE
AUTOS Peraccident $
B X UMBRELLA LIAR X d OCCUR QK09401356 9/15/2011 9/15/2012 EACHOCCURRENCE $ 5,000,000
EXCESS UAB CLAIMS-MADE AGGREGATE $ 5 00,000
DEO I RETENTION$ $
A WORKERSCOMPENSATION WC672515801 9/15/2011 9/15/2012 X I 7NRy IMIT
AND EMPLOYERS'LIABILOY
Y/
ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N/A E.L.EACH ACCIDENT $ 1,000,000
OFFICERMEMBER EXCLUDED?
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 11000,000
f yes,tlaunW under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
C CPL672516201 9/15/2011 9/15/2012
Pollution Legal Liability $5,000,000 Per Incident
including BI/PD 6 Cleanup $5,000,000 Aggregate
$ 25,000 Deductible Each Incident
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach Acord 101,Additonal Remarks Schedule,if more apace Is required)
The Workers' Compensation policy covers 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 EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Ashland AUTHORIZED REPRESENTATIVE
Attn: Purchasing Representative RECORD
90 Mountain Avenue jTY 1 :�C�1 IL
Ashland, OR 97520 ER
Coll:3485062 Tpl:1323364 Cert:16527525 0 1988-2010 ACORD CORPORATION.All rights reserved.
ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD