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HomeMy WebLinkAboutInsurance Certificate: Potelco , 14. R CERTIFICATE OF UIR911 WORNCE DA4/11/DD/YYYY) L~ sn/zms 4/11/2014 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(les) 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 LOCKTON COMPANIES, LLC NCONTACT AME: ~N IF 5847 SAN FELIPE, SUITE 320 A(PH , IC No Eat: ac No: HOUSTON TX 77057 E-MAIL 866-260-3538 ADDRESS, INSURERIS) AFFORDING COVERAGE NAIC e INSURER A: Old Re ublic Insurance Com anv 24147 INSURED POTELCO, INC. INSURER B: ACE Property & Casual[ Insurance CO 20699 1364742 A QUANTA SERVICES COMPANY INSURER C 14103 STEWART RD. _ SUMNER WA 98390 INSURER D: NSURER E: NSURER F: COVERAGES CERTIFICATE NUMBER: 12424201 REVISION NUMBER: XXXXXXX 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 SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDD/YYYY MM/DD LIMITS A GENERALLIABILITY Y N MWZY60331 $/1/2013 5/1/2015 EACH OCCURRENCE 5,000,000 A X COMMERCIALGENERALLIABILITY MWZX300125 $/1/2013 5/1/2015 PREMISES Eao«merc. 5,000,000 CLAIMS-MADE OCCUR MED EXP An one person) 10,000 PERSONAL 8 ADV INJURY $ 5,000,000 GENERAL AGGREGATE $ 5,000,000 GEN-L AGGREGATE LIMIT APPLIES PER. PRODUCTS -COMPIOP AGG $ 5,000,000 POLICY JET LOC $ A AUTOMOBILE LIABILITY Y N MWTB 22002 8/1/2013 5/1/2015 CEOaMBNEEDtSINGLE LIMIT E 5,000,000 X ANY AUTO BODILY INJURY (Per pemon) $ XXXXXXX X AUTOWNED AUTOSULED BODILY INJURY (Per accident s XXXXXXX X HIRED AUTOS X AUTOS OWNED (PPROrPERTY,t) DAMAGE $ XXXXX7 x B X UMBRELLA LIAR } OCCUR N N X00027319774 5/1/2014 5/1/2015 EACH OCCURRENCE $ 51000,000 EXCESS LIIB r-ICI-AIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION E $ XXXXXXX A WORKERS COMPENSATION MWC 11792700 5/1/2014 5/1/2015 X TORYIIMITS DTH- AND EMPLOYERS' LIABILITY YIN N OFFICERIMEMBERRPEXCLUERE ECUTIVE NI NIA E.L. EACH ACCIDENT $ 1,000,000 peandabry In NH) E. L. DISEASE - EA EMPLOYEE 1,000,000 If tes, EesolEe uMet utefnlPf.0v OF OPERATIONS SeI - a L. DISEASE. POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES ItAttach ACORD 101, Additional Remarks Schedule, if mom space is required) THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS HOLDER, APPLICABLE TO THE CARRIERS LISTED AND THE POLICY TERM(S) REFERENCED. Re: All Operations General Liability And Auto Liability Policies Include The City Of Ashland, Oregon, And Its Elected Officials, Officers And Employees As An Additional Insured When Required By Written Contract But Only As Respects Liability Arising Out Of Named Insured's Work For Additional Insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 12424201 AUTHORIZED REPRESENTATIVE The City Of Ashland, Oregon Attn: Kan Ann Olson 90 N. Mountain Ave. Ashland OR 97520 ACORD 25 (2010105) ©1988-2010 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD