Loading...
HomeMy WebLinkAboutInsurance Certificate: Specialty Engineering Inc (2) DATE(MMIDD/YYYY) saw ° CERTIFICATE OF LIABILITY INSURANCE 12/6/2013 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). ONTACT Brenda Nolin, CIC, CISR PRODUCER CNAME: A186k8 ST$A Insurance Brokers PHONE (907)561-1250 FAC o. (907)561-4315 P.O. Box 196530 E-MAIL RESS.b.nolin@alaskausainsurance.com . INSURERS AFFORDING COVERAGE NAIC N Anchorage AK 99519 INSURERA:Evanston Insurance Co. INSURED INSURERB:West American Insurance Company Engineering Inc. INSURER CNavi ators Insurance Company PO Box 5828 INSURERD:Alaska National Ins. Company 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 ADDLSUBR POLICY EFF POLICY SAP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DDNYYY MMIDD/Y YY lua. J= GENERALLIABILITY Beat Ratingi A XIV EACH OCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES E.Eoccurrence $ 50,000 A CLAIMS-MADE ❑X OCCUR X 3PXGWE00294 2/1/2013 12/1/2014 MED EXP (Any one person) $ 5,000 X WA Stop Gay PERSONAL B ADV INJURY S 2,000,000 X Surplus Linea Policy orldwide Facilities Inc. GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS w COMP/OP AGG $ 2,000,000 X POLICY PRO LOC Deductible $ 10, 000 IFCT AUTOMOBILE LIABILITY hill Best Rating: A XV COMBINED SINGLE LIMIT Ea accident 11000,000 B Ix ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED X W1455367084 2/1/2013 2/1/2014 BODILY INJURY (Per accident) $ AUTOS HREDSAUTOS X A NON-O UT SEED P.rraccident AMAGE $ 0 Medical paments $ 5100 UMBRELLA LIAB X OCCUR S Gen Liab, Auto, EmDlyre BEST: A EACH OCCURRENCE $ 10,000,000 C X EXCESS LIAB X CLAIMS~MADE List, Pollution & Prof AGGREGATE $ 10, 000. 000 DED RETENTIONS F13EXC7199081C 211/2013 2/1/2014 Products-ComplOps Aggregate $ 10,000,000 D WORKERS COMPENSATION Best Ratine: A IX X WC STATU. OTH- AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L. EACH ACCIDENT $ 1,000,000 OFFICER E%CLUDED7 3LW959601 12/1/2013 2/1/2014 (M1tandatorY y In in IN INN) E.L DISEASE - EA EMPLOYE $ 1,000,000 ESCRIPTI untler If Yes, dosenti OF - OPERATIONS W. SL&H Included E.L. DISEASE - POLICY LIMIT $ 11000,000 DESCRIPTIONN D A Pollution & Professional 3PKGWE00294 2/1/2013 12/1/2014 Pollution Limst$2,000,00D Ded: $25,000 Liab - Claims Made Surplus Linea Policy Professional Limit: $2,000,000 Ded: $25,000 DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If mom space 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. 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 REPRESENTATNE Ashland, OR 97520 (I /7 H Nolin,' CIC, CISR/BR ~ ,~~Pu._ }g.. / l}'01kj✓[_' ACORD 25 (2010105) ©1988.2010 ACORD CORPORATION. All rights reserved. INS025 (201005).01 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.