Loading...
HomeMy WebLinkAboutInsurance Certificate: Specialty Engineering Inc AcoR°® CERTIFICATE OF LIABILITY INSURANCE DATE (MM DDYYYV) 11/30/2012 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.Insurance Brokers PHONE (907)561-1250 ACX NO: (907)561-6315 e~ t1e€u P.O. Box 196530 - ADDRESS: b.nolint?alaskausainsurance.com PRODUCER usTD 00032358 . Anchorage AK 99519 INSURERS AFFORDING COVERAGE NAIC e INSURED INSURERA:Evanston Insurance Co. INSURERB:Weat American Insurance Company Specialty Engineering Inc. INSURER CNavl ators Insurance Company PO Box 5828 INSURERD:Alaska National Ins. Company 38733 INSURER E Vancouver WA 98668 INSURER F: COVERAGES CERTIFICATE NUMBER:12-13 SEI 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. INSR rypE OF INSURANCE ADDL UBRi POLICY NUMBER MMIOD/YYVV MMIDOV/YVYY LIMITS LTR GENERAL LIABILITY BEST RATING: A XIV EACH OCCURRENCE 5 2,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) $ 50,000 A CLAIMS-MADE ❑X OCCUR X 12PKGO1841 12/1/2012 12/1/2013 VIED EXP(Any one person $ 5,000 X WA Stop Gap PERSONAL It ADV INJURY $ 2,000,000 X Surplus Lines Policy Worldwide Facilitiet,Inc GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO LOC Deductible 10,000 JECT AUTOMOBILE LIABILITY ,MS BEST RATING: A XV COMBINED SINGLE LIMIT (Ea accitlent) $ 1,000,000 X ANY AUTO HA111355367084 121112012 12/1/2013 BODILY INJURY (Per person) $ H ALL OWNED AUTOS X BODILY INJURY (Per eccitlent) $ SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per accident) S X NON-OWNED AUTOS Medical payments $ 51000 Underinsured motorist $ 1, 000, 000 UMBRELLA LIAR X OCCUR tees of General Little, EACH OCCURRENCE $ 10, 000, 000 X EXCESS LAB X CLAIMS-MADE Auto,Employers Liability, AGGREGATE $ 10,000,000 DEDUCTIBLE AM HEST: A X rollution 6 Professional Products-Comp/Ops Aggregate $ 10,000,000 CBI2EXC719908IC 12/1/2012 12/1/2013 Poll 4Prof Liao - Claims Made C LRETENTION $ WORKERS COMPENSATION ----r W'CSTATU- OrH- D AND EMPLOYERS' LIABILITY HEST RATING: A IX X ANY PROPRIETORIPARTNER/EXECUTIVE YIN E.L. EACH ACCIDENT $ 1, 000, 000 (Mandatory E%CLUDEOp O NIA 12LWS59601 12/1/2012 12/1/2013 FFICatery in lr, NH) NH) E. L. DISEASE - EA EMPLOYE $ 1,000,000 If as. describe under SEs. Included DE SCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Pollution & Professional 12FKGOI841 12/1/2012 12/1/2013 Pollution Limit: $2,000,000 Ded: $25,000 Liab core, - Claims Made urplus Lines Policy Professional Limit $2.000,000 Ded: $25,000 DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more apace Is required) Re: Contract for Contractor Services 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 8 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. Kariann Olson, Purchasing Representative 90 N. Mountain Avenue AUTHORIZED REPRESENTATIVE Ashland, OR 97520 f1 B Nolin, CIC, CISR/BR Py2eZ-,ern--... J t~(22.1 ACORD 25 (2009109) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025 (20D909) The ACORD name and logo are registered marks of ACORD COMMENTS/REMARKS ALASKA SURPLUS LINES WORDING APPLIES TO THE 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 Association 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 Y , OFREMARK COPYRIGHT 2000, AMS SERVICES INC. A~O SIP CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDN"Y) I`~ 11/30/2012 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: A18ak8 USA Insurance Brokers PIIONNQ`fs0 (907)561-1250 IAC No): (907)561-6315 P.O. Box 196530 ADDRIE95:b.nolin@alaekausaiaeurance.com PRODUCER 00032358 Anchorage AX 99519 INSURERS AFFORDING COVERAGE NAIC e INSURED INSURER A:Evanston Insurance CO. INSURERB:West American Insurance Company Specialty Engineering Inc. INSURER C:N8vi ators Insurance Company PO Box 5828 INSURERD:Alaska National Ins. Company 38733 INSURER E : V8ncotlver WA 98668 INSURER F: COVERAGES CERTIFICATE NUMBER:12-13 SEI 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. EXP INSR TYPE OF INSURANCE J VO POLICYNUMBER MMPOLICY EFF DONYYY MMIDD POLICY LM IYYYY LIMITS GENERAL LIABILITY HEST RATING: A XIV EACH OCCURRENCE $ 2,000,000 DAMAGE TRENTED 50,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ A CLAIMS-MADE FX] OCCUR X 121PXG01841 12/1/2012 12/1/2013 MED EXP(Any one person $ 5,000 X WA Stop Gap PERSONAL &ADV INJURY $ 2,000,000 X Surplus Lines Policy Worldwide Facilities,Inc GENERAL AGGREGATE s 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY PRO LOG Deductible $ 10,000 JECT AUTOMOBILE LIABILITY HEST RATING: A XV COMBINED SINGLE LIMIT $ 11000,000 A AUTO (Ea accident) X B ALL OWNED AUTOS X AW1355367084 12/1/2012 12/1/2013 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per accident) $ X NON-OWNED AUTOS Medical payments $ 5,000 Underinsured material $ 11000,000 UMBRELLA LIAR X OCCURxcesa of General Liab, EACH OCCURRENCE $ 10,000,000 X EXCESS LIAR X CLAIMS-MADE Auto,Employare Liability, AGGREGATE $ 10,000,000 DEDUCTIBLE AM BEST: A X of lution & Professional Products-Comp/Ops Aggregate $ 10, 000, 000 C RETENTION $ H12EXC7199081C 12/1/2012 12/1/2013 Poll &Prot Lieb - Claims Mace $ D WORKERS COMPENSATION HEST RATING: A IX X WGSTATLI-I-T AND EMPLOYERS' LIABILITY YIN IT$ EEL ANY PROPRIETORIPARTNER/EAECUTIVE NIA E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) 12LWS59601 12/1/2012 12/1/2013 E. L. DISEASE - EA EMPLOYE $ 1,000,00-0 If as describe under BL&H Included DESCRIPTION OF OPERATIONS below E. L. DISEASE-POLICY LIMIT $ 11000,000 A Pollution & Professional 12PKG01841 12/1/2012 12/1/2013 Pollution Limit: $2,001 Ded: $25,000 Liab Cov - Claims Made urplus Lines Policy Professional UmM$2,000,000 Dad: $25,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Re: Mt. View Substations 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 a Ashland, OR 97520 n ~1 p B Nolin, CIC, CISR/HR ~j U- g[~i.~.. ! W.~c~✓C.~ ACORD 25 (2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. I NS025 (200gog) The ACORD name and logo are registered marks of ACORD ` COMMENTS/REMARKS ALASKA SURPLUS LINES WORDING APPLIES TO THE 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 Association 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 s OFREMARK COPYRIGHT 2000, AMS SERVICES INC.