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HomeMy WebLinkAboutInsurance Certificate: Specialty Engineering Inc CERTIFICATE OF LIABILITY INSURANCE 12/6/201) 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 FAX .(907)561-4315 P.O. Box 196530 EMAIL . b. nolinQalaskausainsurance. coin r INSURERS AFFORDING COVERAGE NAIC4 Anchorage AX 99519 INSURER A:Evanston Insurance Co. INSURED INSURERB:West AmiBriCall Insurance Company Specialty Engineering Inc. INSURER C:Navi ators Insurance Company PO Box 5828 INSURERDAlaska National Ins. Company 8733 INSURER E: Vancouver WA 98668 INSURER F: COVERAGES CERTIFICATE NUMBER:13-14 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 ADDL Sulam POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMI MM/ rYYYY GENERAL LIABILITY Ali Beat Rating. A XIV EACH OCCURRENCE $ 2,000,000 U KEN I ED s Occumence S 50,000 X COMMERCIAL GENERAL LIABILITY PRREMISE E A CLAIMS-MADE OCCUR X 3PKGWE00294 2/1/2013 2/1/2014 MED EXP(An one person) $ 5,000 X WA Stop Gap MGENERALAGGREGATES L 8 ADV INJURY $ 2, 000, 000 X Surplus Lines Policy orldtaide Facilities Inc. L AGGREGATE S 2,000,000 GENT AGGREGATE LIMIT APPLIES PERTS -COMP/OP AGG $ 2, 000, 000 X POLICY PRO LOC $ 10, 000 AUTOMOBILE LIABILIBest Rating: A XV D SINGLE LIMIT M 1 000 000 B ANY AUTO JURY (Per person) $ ALL OWNED SCHEDULED X W1455367084 2/1/2013 2/1/2014 NJURY(Per accident) $ AUTOS HREDSAUTOS X AUTOSED Prn DAMAGE $ Medical menis $ 5.000 UMBRELLA UAB X OCCUR S Gen Liab, Auto,Emplyre BEST: A EACH OCCURRENCE $ 10, 000, 000 C X EXCESS DAB X CLAIMS-MADE iab, Pollution & Prof AGGREGATE $ 10,000,000 DED RETENTIONS F13EXC719908IC 2/1/2013 2/1/2014 Products-Comp/Ops Aggregate $ 10,000,000 D WORKERS COMPENSATION Beat Ratine: A IX X WC STATU- OTH- AND EMPLOYERS' LIABILITY 0 ANY PROPRIETOR/PARTNERIEXECUTIVE ~ NIA E.L. EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? 3LWS59601 2/1/2013 2/1/2014 (Mandatory In NH) E.L.DISEASE-EAEMPLOYE $ 1 000,000 If yes, desvite under SL&E Included DESCRIPTION OF OPERATIONS below E.L. DISEASE-POLICY LIMIT S 1,000,000 A Pollution & Professional 3PKGWE00294 2/1/2013 2/1/2014 Pollution Limrt$2,000,000 Ded: $25,000 Liab - Claims Made Surplus Lines Policy Professional Limit: $2.000,000 Ded: $25,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, K 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 & exclusions. ~C~J _11A 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 AUTHORIZED REPRESENTATIVE 90 N. Mountain Avenue Ashland, OR 97520 B Nolin, CIC, CISR/BR e7u_-a 211 -4. t1 f L.O-O_j✓c ~ ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 (201005).Dl The ACORD name and logo are registered marks of ACORD COMMENTS/REMARKS ALASKA SURPLUS LINES WORDING: "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 OFREMARK COPYRIGHT 2000, AMS SERVICES INC.