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HomeMy WebLinkAboutInsurance Certificate: Quality Fence Co Reliable Electric QUALFEN-01 ATHOMPSON CERTIFICATE OF LIABILITY INSURANCE DA1v14/20 2 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS i 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. r IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to j 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 DBA: Western States Insurance Agency of McMinnville PHONE - FAX Western States Insurance Agency, Inc. A/c, No, Ext)- (503) 472-2121 INN No); (503) 434-5872 - -I P.O. Box 269 E-MAIL Mcminnville, OR 97128 ADDRESS: _ INSURER(S) AFFORDING COVERAGE NAIC 1 INSURER A_Hallmarklnsurance Group INSURED INSURER B: Duality Fence Co Reliable Electric Western Vinyl ProductS INSURER C:- Steve Rletma0n INSURER D: PO BOX 398$ INSURER E_ Central Point, OR 97502 INSURER F: COVERAGES _ CERTIFICATE NUMBER: _N I_ REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVEBEESSUED 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 I _ TYPE OF INSURANCE POLICY EFF POLICY EXP , INSR1VN0_ POLICY NUMBER NUMBER IMMIDD/YYYY) IMMIDD/YYYYI • LIMITS i GENERAL LIABILITY I j - EACH OCCURRENCE $ 1,000,000- 1 A I X ! COMMERCIAL GENERAL LIABILITY X 144CL466835 1111912012' 11/19/2013 'AMAGET6RENTE~ 1gg,D00' PREMISESlEaoccunence l ! $ CLAIMS-MADE X j OCCUR I~ I MED EXP (Anyone person) ' 1 5,000 PERSONAL & ADV INJURY I $ ~11000,000 GENERAL AGGREGATE I, $i 2,000,000! GENT AGGREGATE LIMIT APPLIES PER. _ 1 I PRODUCTS -COMPIOPAGG ! $ 2,000,000' -1 I . PRO POLICY E LOC _ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 jEa accitlent) S A A ANY AUTO X 144CL466835 j 1111912012; 11/19/2013 , BODILY INJURY (Per Penwn) j $ I ALL OWNED SCHEDULED I :BODILY INJURY (Par eccitlent) 8 j AUTOS AUTOS _ -i NON-0NMED PROPERTY DAMAGE HIRED AUTOS AUTOS $ j P( ER ACCIDENTI ! - $ X UMBRELLA LIgB X OCCUR EACH OCCURRENCE $ 3,000,00 A EXCESS LUIS CLAIMSWADE: i44CU466836 111/1912012 11/1912013 AGGREGATE S (OED X I RETENTIONS 10,000i 13,000,000 113,000,000 i is WORKERS COMPENSATION WC STATU- IOTH-I AND EMPLOYERS' LIABILITY YIN 1 I CORY-LIMJTS I ER ANY PROPRIETORIPARTNER/EXECUTIVE-, E.L. EACH ACCIDENT s j OFFICEMY in NREXCLUDED? N/A. I-(Mantlatory in NH) E1 . DISEASE - EA EMPLOYEE $ 1 D SCRIPTIONOPOERATIONS below --`E.L _DISEASE--POLICY LIMIT A Commercial Property 144CL466835 11/19/2012 11/19/2013 (leased eq 25,000 j DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Much ACORD 101, Atltlnlonsl Remerb Schedule, N more space is required) jThis certificate is provided as evidence of liability insurance but only as respects liability arising out of the activities by and on behalf of the named Insured CERTIFICATE HOLDER _ CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE City of Ashland DELIVERED IN 20 East Main ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520-__ AUTHORIZED REPRESENTATIVE I I ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD QUALFEN-01 ATHOMPSON ACORO~ CERTIFICATE OF LIABILITY INSURANCE 11/14 D//2 Yol2 z 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: DBA: Western States Insurance Agency of McMinnville PHONE 503 472-2121 FAX Western States Insurance Agency, Inc. A/c IN Eat : ( ) Arc Na : (503) 434-5872 P.O. BOX 269 E-MAIL ADDRESS: Mcminnville, OR 97128 INSURERS) AFFORDING COVERAGE NAICp INSURER A: Hallmark Insurance Group INSURED INSURER B Quality Fence Co Reliable Electric Western Vinyl Products INSURER C Steve Rietmann INSURER D PO Box 3985 Central Point, OR 97502 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 SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL UBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MWDD/YYYY MMIDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X 44CL466835 11119/2012 11119/2013 DAMA EISE T RENTED 100,000 PREMS (Ea occurrence $ CLAIMS-MADE FX I OCCUR MED EXP (Any one person) $ 5,000 PERSONAL B ADV INJURY $ 1,000,000' GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER IPRODUCTS - COMP/OPAG$$ 2,000,000 POLICY PRO LOC $ PQT AUTOMOBILE LIABILITY (e eccl OeDtSINGLE LIMIT $ 1,000 000 A X ANY AUTO X 44CL466835 11/1912012 1111912613 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS H AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS PER ACCIDENT Is X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 A EXCESS LIAB CLAIM"ADE 44CU466836 11/19/2812 11/1912013 AGGREGATE $ DIED X RETENTION $ 10,000 3,000,000 $ WORKERS COMPENSATION !%RSTA ER TH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E. L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Commercial Property - 44CL466835 11/19/2012 11/19/2013 leased eq 25,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (AUnch ACORD 101, Additional Remarks Schedule, V more space is required) City of Ashland is additional insured as respects liability arising out of the activities by and on behalf of the named insured CITY RECO^Cltm CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Karl Olson,PUrchasing Repr ACCORDANCE WITH THE POLICY PROVISIONS. 90 N Mountain Ave Ashland, OR 97520 AUTHORIZED REPRESENTATIVE 3 ~~1.,J1(milwv- ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010/05) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: - COMMERCIAL GENERAL-LIABILITY GC 10.25 07 09 THIS ENDDRSEMENT-CHANGES THE POLICY.: PLEASE READ. IT CAREFULL OREGON BLANKET ADDITIONAL 'INSURED COMPLETED :OPERATIONS This endorsement modifies insurance provided underthe following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II - Who Is An Insured is amended to include as an additional Insured.any person or.organization for whom you are:performing operations when you and such person or.organization have agreed to writing In • . a contract or agreement thatsuch person or organization be added as an additional insured for:completed - . operations. Such person or organization Is an additional Insured only to.the extent that.the liability for ".bodily injury" or "property damage" Is caused, In whole or In part, by "your work" performed for that additional.In- sured and included in the 'products-completed operations. hazard.". B. With respect to the Insurance afforded to these additional insureds, the following limitations apply: 1. This additional insured status is granted only at the locations listed in the written contract: 2. Coverage Is.limited to "your work" that is described in the classifications or schedule of hazards shown in the General Liability Declarations of this policy. C. With respect to the insurance afforded to these additional insureds; .the following exclusion applies: This insurance does not apply to: 'Bodily injury' or "property damage' which occurs prior to the execution of the written contract or the effec- . . tive date of this endorsement. i i i I I GC 10 25 07 09 Includes copyrighted material of - Page 1 of 1 ❑ Insurance Services Office, Inc., with Its permission -