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Insurance - Eco Partners Inc. - Workers Comp -2019-07-18
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 07/18/2019 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 SUBROGATIONIS 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 AUTOMATIC DATA PROCESSING INS AGCY CONTACT NAME: PHONE (877) 287-1316 (A/C, No, Ext): FAX (888) 443-6112 (A/C, No): 76250717 71 HANOVER ROAD E-MAIL ADDRESS: FLORHAM PARK NJ 07932 INSURER(S) AFFORDING COVERAGE NAIC# INSURER A : Hartford Casualty Insurance Company/ 29424 INSURED INSURER B: ECO PARTNERS INC. INSURER C: PO BOX 496 INSURER D: CARMEL IN 46082-0496 INSURER E DAMAGE TO RENTED 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/Y YYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS -MADE ❑ OCCUR DAMAGE TO RENTED PREMISES Ea occurrence MED EXP (Any one person) PERSONAL & ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY FI PRO- F]LOC JECT PRODUCTS - COMP/OP AGG OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) HIRED NON -OWNED PROPERTY DAMAGE AUTOS AUTOS (Per accident) UMBRELLA UAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS - MADE AGGREGATE DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY X I PER OTH- STATUTE ER E.L. EACH ACCIDENT $100,000 A ANY Y/N PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA X 76 WEG D16609 08/15/2019 08/15/2020 E.L. DISEASE -EA EMPLOYEE $100,000 (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. Notice of Cancellation will be provided in accordance with Form WC990394, attached to this policy. Waiver of Subrogation applies in favor of the Certificate Holder per Waiver of our Right to Recover from Others Endorsement WC000313 attached to this policy. K"A:491a[y_%114:IC40 4: •11 Costa Mesa Sanitary District SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 290 PAULARINO AVE BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED COSTA MESA CA 92626-3314 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THE HARTFORD BUSINESS SERVICE CENTER THE 3600 WISEMAN BLVD HARTFORD SAN ANTONIO TX 78251 Costa Mesa Sanitary District 290 PAULARINO AVE COSTA MESA CA 92626-3314 Account Information: Policy Holder Details : ECO PARTNERS INC. July 18, 2019 %1P Contact Us Business Service Center Business Hours: Monday - Friday (7AM - 7PM Central Standard Time) Phone: (877) 287-1316 Fax: (888) 443-6112 Email: agency. servicesa-thehartford.com Website: https:Hbusiness.thehartford.com Enclosed please find a for the above referenced Policyholder. Please contact us if you have any questions or concerns. Sincerely, Your Hartford Service Team