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HomeMy WebLinkAboutInsurance Certificate: Michels Corporation MICHE-8 OP ID: KS A DATE IYYVYJ CERTIFICATE OF LIABILITY INSURANCE 01/24/14 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 endorsements). PRODUCER Phone: 630-245-4600 NAMEpCT Weible 8 Cahill PHONE FAX 2300 Cabot Drive, Suite 100 Fax: 630-245-4601 Alc Nd Est : ac Noll: E-MAIL Lisle, IL 60532 ADDRESS: William P. Wei Weible INSURERS AFFORDING COVERAGE NAIC Is INSURERA:Arch Insurance Company 11150 INSURED Michels Corporation INSURER e: National Fire & Marine Ins Co 20079 1715 16th Street SE INSURERC:Arch Indemnity Insurance Co 30630 Salem, OR 97302 INSURER 0: 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 L ruffn POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMIYDNYYY MMIYD/YYYY hm ma GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 S- R tiAMAG300,00 A X COMMERCIAL GENERAL LIABILITY X 41PKG6915305 02101114 02101115 PREMISES Ea occurrence $ CLAIMS-0 E OCCUR NIED EXP(my.. person) $ 10,00 X XCU Included PERSONAL B ADV INJURY S 1,000,00 X Stop Gap Included GENERAL AGGREGATE. $ 2,000,00 PRODUCTS - COMP/OP AGO S 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER E POLICY X PRO LOG COMBINED SINGLE LIMIT AUTOMOBILE UABRJTY acddenl $ 2,000,00 A X ANY AUTO X 41PKG8915305 02101114 02101115 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS PROPERTY DAMAGE $ X HIRED AUTOS X NON-OWNED AUTOS Per accitlenl $ X MCS 90 UMBRELLA LUIB X OCCUR EACH OCCURRENCE $ 10,000,00 B X EXCESS UAB CLAIMS-MADE 42XSF10013901 02101114 02101115 AGGREGATE $ 10.000,0010 DED X RETENTIONS O $ WC STATU- OTH- WORKERSCOMPENSATION X RY A R LIABILITY A ANY ANY EMPLOYERS' NERIE%ECUTIVE YIN 41WC18915105 02101114 02/01115 E.L. EACH ACCIDENT $ 1,000,00 C OFFICERIMEMBI 44WCI8915205 (NY ONLY) 02101114 02/01115 EL, DISEASE - EA EMPLOYEE E 1,000,00 (Mandatory in Nr,rinN )E%CLUDED7 ON NIA H) Ilgs.deac"od under E.L. DISEASE - POLICY LIMIT E 1,000,00 DESCRIPTION OF OPERATIONS Del. DESI RIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) Re: Michels Job #30416, Ashland Creek Sanitary Trunk Sewer - CIPP Linin, Phase 2 Additional Insured on General Liability and Auto: The City of Ashland, and its agents, officers, and employees *Per CG2010 7/04, CG2037 7/04, CA2048 2/9 and OOMLOO8700 CERTIFICATE HOLDER CANCELLATION ASHLA-0 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- 20 E. Main Street Ashland, OR 97520 AUTHORIZED REPRESENTATIVE I © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: atPKGSS153o5 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Locations Of Covered Operations Any person or organization for whom you are required in a written contract or agreement to include as an additional insured. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional exclu- organization(s) shown in the Schedule, but only sions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" property damage" occurring after: caused, in whole or in part, by: 1. All work, including materials, parts or equip- 1. Your acts or omissions; or ment furnished in connection with such work, 2. The acts or omissions of those acting on your on the project (other than service, mainte- behalf; nance or repairs) to be performed by or on be- half of the additional insured(s) at the location in the performance of your ongoing operations for of the covered operations has been completed; the additional insured(s) at the location(s) desig- or nated above. 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 ❑ POLICY NUMBER: 41PKG8915305 COMMERCIAL GENERAL 1 0704 RA 20361 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Opera- Or Organization(s): tions Any person or organization for whom you are required All construction operations of the named insured where in a written contract or agreement to include as an required by written contract. additional insured. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section 11 - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products- completed operations hazard". CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 ❑ Policy #41 PKG8915305 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance, and CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: 41PKG8915305 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provi- sion of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicat- ed below. Endorsement Effective: 2/1/14 Countersigned By: Named Insured: Michels Holdings, Inc. hG~ .~CiCUiCI¢L Authorized Representative) SCHEDULE Name of Person(s) or Organization(s): Any person or organization, when required by written contract or agreement, are an additional insured. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 ❑ I THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION- CERTIFICATE HOLDERS (SPECIFIED DAYS) The person(s) or organization(s) listed or described in the Schedule below have requested that they receive written notice of cancellation when this policy is cancelled by us. We will mail or deliver to the Person(s) or Organization(s) listed or described in the Schedule a copy of the written notice of cancellation that we sent to you. If possible, such copies of the notice will be mailed at least 30 days, except for cancellation for non-payment of premium which will be mailed 10 days, prior to the effective date of the cancellation, to the address or addresses of certificate holders as provided by your broker or agent. Schedule Person(s) or Organization(s) including mailing address: All certificate holders where written notice of the cancellation of this policy is required by written contract, permit or agreement with the Named Insured and whose names and addresses w ll be I Lprovided by the broker or agent listed in the Declarations Page of this policy for the purposes of complying with such request. This notification of cancellation of the policy is intended as a courtesy only. Our failure to provide such notification to the person(s) or organization(s) shown in the Schedule will not extend any policy cancellation date nor impact or negate any cancellation of the policy. This endorsement does not entitle the person(s) or organization(s) listed or described in the Schedule above to any benefit, rights or protection under this policy. I Any provision of this endorsement that is in conflict with a statute or rule is hereby amended to conform to that statute or rule. All other terms and conditions of this policy remain unchanged. Endorsement Number: Policy Number: 41PKG8915305 Named Insured:MICHELS HOLDINGS, INC. This endorsement is effective on the inception date of this Policy unless otherwise stated herein: Endorsement Effective Date: 00 ML0087 00 11 10 Page 1 of 1