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HomeMy WebLinkAboutInsurance Certificate: Pacific Electrical OP ID: RMB CERTIFICATE OF LIABILITY INSURANCE 07/01 DAT /13 07101113 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 541-245-1111 CONTACT Marcia Pollman United Risk Solutions, Inc. NAME` PO Box 936 541-245-11121NC,N Eat:541-245-1111 INC FAX. No): 541-245-1112 Medford, OR 97501.0067 ADDRESS: marcia.pollman@unitedrisk.com PRODUCER PAC107C CUSTOMER ID p: r1+ INSURERS AFFORDING COVERAGE NAIC # INSURED Pacific Electrical C- 7 L INSURER A: Amco Insurance Co 19100 Contractors, Inc. INSURER B: 920 S. Grape St. Medford, OR 97501-0106 INSURER C INSURER D 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 TYPE OF INSURANCE ADDL WSUER VDI POLICY NUMBER MMDDY/YYEFF YY MM/DD INRR LTR /YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X ACPMCT07525127599 07/01/13 07/01114 PREMISES Ea occurrence) $ 100,000 CLAIMS-MADE X OCCUR MED EXP (Any one person) $ 5,000 X Per Project PERSONAL &ADV INJURY $ 1,000,000 Aggregate Limit GENERALAGGREGATE $ 2,000,000 GENT, AGGREGATELIMIT APPLIES PER: PRODUCTS - COMPIOP AGO $ 2,000,000 POLICY X PRO LOC $ AUTOMOBILE LIABILITY X COMBINED SINGLE LIMIT $ 1,000,000 (Ea A X ANY AUTO ACPBAPD7525127599 07101113 07101114 accident) BODILY INJURY (Per person) $ ALL OWNED AUrOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIREDAUTOS (Per accident) $ NON-OWNEDAUTOS $ X UMBRELLA UM X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 A ACPCAA7525127599 07101/13 07/01114 DEDUCTIBLE $ X RETENTION $ 10,000 $ WORKERS COMPENSATION CSTATU- OTH- AND EMPLOYERS' LIABILITY Y / N TWRV LIMIT ER ANY PROPRIETOILPARTNERIEXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBE R EXCLUDED? N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ If Yes, describe under DESCRIPTION OF OPERATIONSbelow E.L. DISEASE - POLICY LIM IT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Project: Ashland Substation Modifications The City of Ashland, Oregon, and its elected officials, officers and employees are Additional Insured per endorsement CG7323 11111, Primary and Non-Contributory. The above stated are also Additional Insured per endorsement AC0102 03110. 30 day notice of Cancellation per endorsement IL7002 09111. CERTIFICATE HOLDER CANCELLATION CITAS01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 90 N. Mountain Ave. ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520.2014 AUTHORIZED REPRESENTATIVE ©1988.2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD