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HomeMy WebLinkAboutInsurance Certificate: Specialty Engineering Inc ,aco CERTIFICATE OF LIABILITY INSURANCE DATE IMMIDDIVVVV) 11/30/2011 `,�„✓ 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 Brenda'Nolin, CIC, -CISR NAME: Alaska USA: InsuranceeBrokers i s PHONE (907)561-1250 " FAX '(907)561-4315' 1Alt No-Eyn; LIC No):__ __ P.O. Box 196530 EAILSS:b.nolin @alaskausainsurance:com PRODUCER 00032358 CUSTOMERIDJI:_ - Anchorage AK 99519 INSURERS)AFFORDING COVERAGE — NAICN INSURED INSURER A:Evan a ton Insurance Company INSURERS West American Insurance Company_ _ Specialty Engineering Inc. INSURERC:Nayi ators Insurance Company 42307 PO Box 5828 INSURERD:Alaska National Ins. Company�38733 INSURER E: Vancouver WA 98668 INSURER F: COVERAGES CERTIFICATE NUMBER:11-12 D & L Master 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. ILTR TYPE OF INSURANCE nDDLiSUeR POLICY NUMBER MMIDD/YYYY MMIDOIYYYV LIMITS GENERAL LIABILITY AM BEST RATING: A XIV EACH OCCURRENCE $ 2,000,000 DAMAG T-RENTED 50,000 X COMMERCIAL GENERAL LIABILITY PREMISESLaocw nc rree $ 12/1/2011 12/1/2012 A CLAIMS-MADE OCCUR X 11PKGO1841 MED EX,(An y one person) $ 5,000 X WA Stop Gap PERSONAL&ADV INJURY, $ 2,000,000 X Surplus Linea Policy Worldwide Facilities GENERAL AGGREGATE ..S 2,000,000 GENT AGGREGATE LIMIVAPPLIES PER PRODUCTS-COMPIOP AGG. E'_ . 2,000;000 �X POLICY�IPRD- nLOC "'r Deducible: __ __ $„ ,$10,000'JECT AUTOMOBILE LIABILITY AM BEST RATING: A XV COMBINED SINGLE LIMIT g 1,000,000 X - ; (Ea acciaem) ANY AUTO" BODILY INJURY(Per person) $ —` B : ALL DWNED AUTOS -- X AW1254282005 -" 12/1/2011 12/1/2012 BODILY INJURY(Per accitlenl) $ SCHEDULED AUTOS - PROPERTY DAMAGE X HIRED AUTOS (Per aceitlenU $ X NON-OWNED AUTOS Medical payments S 5,000 Uninsured motorist combined $ 1, )00,000 UMBRELLA LIAR X OCCUR xcase of General Liab, EACH OCCURRENCE _ S 4,0000000 }( EXCESS UAB X CLAIMS-MADE AUto,Employers Liability, AGGREGATE $ 4,000,000 DEDUCTIBLE AM BEST: A X iPollution & Professional ProtludsComp/Ops Aggregate g 4,000,000 C _RETENTION $ CHIIEXC719908IC ,12/1/2011 12/1/2012 Poll&Prot Liab-Claims Made g D WORKERS COMPENSATION �— AM HEST RATING: A IX II X WC S'i Al"U OTHI AND EMPLOYERS' ARTNITY OAY11MlIS FIR I ANY PROPRIETOR/EXCLUDED' Y/N ILE.L EACH ACCIDENT $ 1,�00,000 OFFICERIMEMBER ExCLUDED? NIA 12/1/2011 12/1/2012 (Mandatory in NH) 11LW359601 El DISEASE-EA EMPLOYE $ 1,000,000 If yes describe under USL&H Included E.L.DISEASE POLICY LIMIT $ 1 000 000 DESCRIPTION OF OPERATIONS below A Pollution Liab-Claim sMade 11PKGOI841 12/1/2011 12/1/2012 Llmit:$2,000,000 Ded: $25,000 Prof Liab - Claims Made )Surplus Lines - WWF Lm $2000,000 Ded: $25,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional RemarlMs Schedule,if more space Is required) Re: Mt. View Substation's Voltage Regulator Emergency Repairs The Certificate Holder is an Additional Insured on the General Liability & Automobile policies, but only with respect to work done by or on behalf of the named insured for the project referenced. Subject to policy terms, conditions & exclusions. CERTIFICATE HOLDER CANCELLATION (541)488-5320 Olson @ashland.or.us SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Dave Tygerson 90 N. Mountain Avenue AUTHORIZED REPRESENTATIVE Ashland, OR 97520 /, (} �� B Nolin, CIC, CISR/BR flTLvir• �ti .. ! LG.-L%f,-I-z� ACORD 25(2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(200909) The ACORD name and logo are registered marks of ACORD COMMENTS/REMARKS ALASKA SURPLUS LINES WORDING APPLIES TO GENERAL LIABILITY, EXCESS LIABILITY, POLLUTION LIABILITY AND PROFESSIONAL LIABILITY POLICY PLACEMENTS: "This is evidence of insurance procured and developed under the Alaska Surplus Lines Law AS21.34 . It is not covered by the Alaska Insurance Guarantee ssociation Act, AS21 .80. This insurer does not hold a certificate of authority with Alaska, and is not subject to supervision by the Alaska Department of Insurance" Worldwide Facilities, Inc. - License #9718 OFREMARK COPYRIGHT 2000, AMS SERVICES INC.