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ERTIFICATION OF INSURANCE
Client#: 1431801
ACORD.
CERTIFICATE OF LIABILITY INSURANCE
UNIVEREC
DATE (MIDDIYYYY}
FAU2017
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
certificate holder fn lieu of such endorsement(s).
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
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies} must be endorsed. if SUBROGATION [S WAIVED, subject to
the terms and conditions of the policy, certain polictes may require an endorsement. A statement on this certificate does not confer rights to the
PRODUCER
USI Insurance Services LLC
2021 Spring Road, Suite 100
Oak Brook, iL 60523
SOMACT Kristin Schenn
FONE, ex: 630 625-5202
EMAL... kristin.schenn@usi.com
[AS ne, 810 537-9264
Universal Recycling Technologies LLC
INSURER(S) AFFORDING COVERAGE NAIC €
312 442-7200 INSURERA: ZuTich American insurance Co. 16535
INSURED wsurer s ; Nautilus Insurance Company 417370
2535 Beloit Avenue —— 7
Janesvilie, WI 53546 -
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 SUGH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ine TYPE CF INSURANCE Ween POLICY NUMBER aay aD) LIMITS
A |X| COMMERCIAL GENERAL LIABILITY CPO038475500 07/06/2017 | O7/06/201 | EACH OCCURRENCE $1,000,000
CLAIMS-MADE OCCUR BAMARES ecctumence) | $4,000,000
| MED EXP (Any ona person) | $40,000
|| PERSONAL RADVINUURY | $4,000,000
| GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
|__| poucy x] Teor [| Loc PRODUCTS. COMP/OP AGG | 52,000,000
OTHER: s
A | AUTOMOBILE LIABILITY CPO038475500 07/06/2017 | 07/06/2018 feascouery ts 7,000,000
Xi any auto BODILY INJURY {Per person} 5
| AT SCHEDULED BODILY iNJURY (Per accldan) | $
_X! uinep autos Autos rerscoueny SE 7
$
A |_| UMBRELLA LIAB 1X occur AUCO38476400 07/08/2047 | 07/06/2018 EACH OCCURRENCE $40,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000
DED | X{ retention $10,000 _ _ 3
EO eee ates LIABILITY va WC038476100 priser 7/07/06/2018 X |srarure ifn
ANY PROPRIETORIPART NEREXECUTIVE NIA £.L. EACH ACCIDENT $1,000,000
{Mandatory In NH} ELL. DISEASE - EA EMPLOvEE| $1,000,000
BESERIETION OF OPERATIONS batow EL. osease -poucy tim | 31,000,000
B Pollution Liab. §SP202310110 07/06/2017 [07/06/2018 $10,000,000/$25,000 Ded
Insured Location Schedule:
2535 Belolt Avenue, Janesville, Wi 53546
420 E Burbank Avenue, Janesville, WI 53546
2304 Franklin Drive, Ft. Worth, TX 76106
10151 SE Jennifer Street, Clackamas, OR $7015
61 Industrial Park Drive, Dover, NH 03820
DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES {ACORD 101, Additional Ramarks Schedule, may be attached If more space is required)
CERTIFICATE HOLDER
CANCELLATION
Universal Recycling
Technologies LLC
2535 Beloit Avenue
Janesville, WI 53546
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL SE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
a ep lier
ACORD 25 (2014/01) 4 nf
The ACORD name and toac are reaistered marks af ACORD
© 1988-2014 ACORD CORPORATION, All rights reserved.
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