HomeMy WebLinkAboutInsurance Certificate: Osmose Utilities Services
A` °RO® CERTIFICATE OF LIABILITY INSURANCE 6/18/2013 '
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 I 1 NAMTACT Christie Geiger
First Niagara Risk Management, Inc PHONE (716) 819-5500 FAX . (716)819=5140
DDRE _ Christie. Geiger@form. com
726 Exchange Street Suite 900 AE-MAL
INSURER(S) AFFORDING COVERAGE NAIC If
Buffalo NY 14210 INSURER A:Hartford Fire Insurance Company 19682
INSURED INSURERB:Nattl Union Fire Ins CO of PA 19445
Osmose Utilities Services Inc INSURER C:Travelers Pro Cas Co of Am 5674
980 Ellicott Street INSURER D:
INSURER E
Buffalo NY 14209 INSURER F:
COVERAGES CERTIFICATE NUMBER:13-14 OUS 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 BR POLICY EFF POLICY EXP LIMITS
TR TYPE OF INSURANCE POLICY NUMBER MMIDDiYYYY1 MMD
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
DAMAGE
X COMMERCIAL GENERAL LIABILITY REMISETE RENTEDa 500,000
A CLAIMS-MADE OOCCUR X X 1 DEN ON 2007 /1/2013 /1/2014 MED F.XP(M one person) $ 10,000
X Contractual Liability PERSONAL B ADV INJURY $ 1,000,000
X XCU included „ GENERAL AGGREGATE $ 2,000,000
GENL AGGREGATELIMIT APPLIES PER: - PRODUCTS - COMP/OP AGG $ 2,000,000
POLICY X PRO- X LOC $
IFCT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
i aaccident) 3,000,000
A Ji BODILY INJURY(Per person) $ MY AUTO
ALL OWNED SCHEDULED X X 1 UEN OH2O08 /1/2013 /1/2014 BODILY INJURY(Per accident) $
ARED N N-0V, ED PROPERTY DAMAGE HIRED AUTOS X AUTOS (Per ¢iden
X UMBRELLA LAB X OCCUR X X EACH OCCURRENCE $ 25,000,000
B EXCESS LIAB CIAIMS-MADE E 018085665 AGGREGATE $ 25,000,000
DED X RETEWION$ 10,00 /1/2013 /1/2014 Is
OIR
I J-1
A WORKERS COMPENSATION X X WC STATLL
AND EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIVE N NIA E.L. EACH ACCIDENT $ 1,000,000
OFFICER/MEMBER EXCLUDED? 1 WE OR 2006 /1/2013 /1/2014
(Mandatory In NH) E.L. DISEASE - EA EMPLOYE $ 1,000,000
I nzcesr'oreop1in6u under
ccveTinn,c E.L. DISEASE - POLICY LIMIT $ 1,000.000
C Leased/Rented Equipment T660342OP452TIL12 /1/2013 /1/2014 it 1,400,000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
The City of Ashland, Oregon, and its elected officials, officers and employees are Additional Insured on
a primary and non-contributory basis in regard to the above Liability policies when required by executed
written contract. A Waiver of Subrogation is included when required by executed written contract.
Workers Compensation coverage is extended to the state of Oregon.
CERTIFICATE HOLDER CANCELLATION
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.
90 N. Diountain Avenue
Ashland, OR 97520 AUTHORIZED REPRESENTATIVE
Bruce Rogers/CGEIGE r2
ACORD 25 (2010105) 01988-2010 ACORD CORPORATION. All rights reserved.
INS025 (201005).01 The ACORD name and logo are registered marks of ACORD