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HomeMy WebLinkAboutInsurance Certificate: Pierce Manufacturing CITY RECORDER O r- DATE (0 2014 Y) A CERTIFICATE OF LIABILITY INSURANCE o3i3ozg14 THIS "CERTIFICATE;IS.ISSUED AS A MATTER OF INFORMATION ONLY CONFERS NO 'RIGHTS `UPON' THE CERTIFICATE HOLDER. THIS I I CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE: AFFORDED. BY THE,POLICIES I BELOW. "'THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED -1 REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. t IMPORTANT: If the certificate holdenis an ADDITIONAL INSURED, the polies/lies) must be endorsed.Fif SUBROGATION IS- WAIVED; .stibJect.to I the terms and conditions of the, policy; certaln policies may require an endorsement. A statement on this certificate does'not co_nfer iights the certificate u. holder in lleof such endorsement(s). 1': -l. n1;11'.';, PRODUCER 1 443 0000 CONTACT NAME: .J Hays. Companietof Wisconsin, Inc PHONE- s' INC No Fxtl: I (AIC, No):I 1200 North Mayfair Road, Suite 100 ADDRESS: Milwaukee, WI 53226 INSURER(S) AFFORDING COVERAGE NAIL INSURER A: NATIONAL FIRE MARINE INS CO 20079 INSURED INSURER B: TRAVELERS PROPERTY CAS CO OP AMER 25679 Pierce Manufacturing Inc. INSURER C PHOENIX INS CO 25623 P.O. Box 2017 INSURER D: BERRLEY NATL INS CO 38911 Appleton, WI 59912 2017 INSURER E:' INSURER F COVERAGES CERTIFICATE NUMBER: 39069085 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. ILTR TYPE OF INSURANCE 'NCR $WV P D POLICY NUMBER ODCY Y EFF POLICEXP LIMITS lM OLIC Y EFF I FOLIC EXP A; GENERALWBIUTY X 42 100190 09/01/19 04/01/15 EACH OCCURRENCE $1,000,000 COMMERCIALGENERALLIABILITY PREMISES (Ea occurrence) f 500 000 I gIAIMS MADE I X OCCUR T 4ity t c t !'f 1 1 F:1 1 f 1 3 t 1 ?MED EXP (Any one person) xcluded T 000,.000 un±c n,._ a lit J,.- t i PERSONAL SAD V INJURV'_.E: ,..,.f r c.. .1 hl- k 1.111:,. i,... L._!' GENERAL AGGREGATE t GFN1`AGGREGATCLIMITAPPLIESPER:- "'it; L,e_d 11.3-1 Lf '7 4c 3 PRODUCTS COMP/OPAGG 1,000,000 i r '.X POLICY t::PRy c LOC t \L v �u l .f: •.n El 10/01/1a 10/01/14 COMBINED SINGLE LIMIT 'AUTOMOBILE DABILnY], 1,000,000, IEe ectl 3 X. ANY AUTO :BODILY INJURY (Per person) ALL OWNED SCHEDULED BODILY INJURY (Per accident) AUTOS AUTOS NON -OWNED PROPERTY DAMAGE S HIRED AUTOS AUTOS (Per emdant) A X UMBRELLA LIAB X OCCUR 42 100191 09/01/14 04/01/15 EACH OCCURRENCE 15,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE 15,000, DED RETENTION$ B WORKERSCOMPENSADON TRJUB117D757713 10/01/13 10/01/14 X IW CSTATU NTH- AND EMPLOYERS' LIABILITY Y /N C ANY PROPRIETOR/PARTNER/EXECUTIVE TC2NU B117D756513 10/01/1? 10/01/19 El. EACH ACCIDENT 51, -000,000 OFFICER/MEMBER EXCLUDED? I a A (Mandatory in NH) E.L. DISEASE EA EMPLOYEE 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE POLICY LIMIT 1,000,000 D Excess Liability CEX0960017401 04/01/14 04/01/15 Ea Occ /Agg 10,000,000 DESCRIPTION OF OPERATIONS LOCATIONS VEHICLES (Attach AGGRO 101, Additional Remarks Schedule, It more apace Is required) Additional Insured when required by written contract. Two (2) Pierce Dash CP Pumpers CERTIFICATE HOLDER CANCELLATION 27255 -1 -2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 90 North Mountain Avenue AUTHORIZED REPRESENTATIVE Ashland, OR 97520 gB Q,,: USA j ©1988.2010 ACORD CORPORATION. All rights reserved.. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD diannewandel 39064085