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HomeMy WebLinkAboutInsurance Certificate: Liquid Engineering LIQUENG-02 CTHELEN DA Y) AcoRL7' CERTIFICATE OF LIABILITY INSURANCE 4/29/D0/YYY 4/29/2014 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(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 NAME: Billings-2nd Ave. Office a/CO No Ell, (406) 238-1900 FaAX No PayyneWest Insurance, Inc. Ar N P.O. Box 30638 AE-MAIL DDRESS: Billings, MT 59107-0638 INSURER(S) AFFORDING COVERAGE NAICp d1SURERA: Homeland Ins Co of New York INSURED INSURER B:AtiantiC Specialty Insurance Company Liquid Engineering Corporation INSURERC:State Compensation Ins Fund of MT P.O. Box 80230 INSURER D: Zurich American Insurance Billings, MT 59108-0230 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. LTR INS INSR TYPE OF INSURANCE POLICY NUMBER MMIDY/YYYY M ODY/YYY LIMITS A TCOMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE FT] OCCUR X 7930021220000 0510112014 05/01I2015 PREMISES Ea occurrence $ 50,00 MED EXP (My one person) $ 5,00 PERSONAL S ADV INJURY E 1,000,00 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,00 POLICY [7X jECT F ~ LOC PRODUCTS - COMP/OP AGG $ 2,000,00 OTHER: Employee Benefi $ 2,000,00 AUTO MOBILE LMBILITY COMBINEDSINGLE LIMIT $ 1,000,00 Ee acddent B ANY AUTO 793002120000 05/01/2014 051011201$ BODILY INJURY (Per person) $ , ALL OWNED X SCHEDULED BODILY INJURY (Par accident) E AUTOS AUTOS X X NONOVINED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 2,000,00 A EXCESS LMS CLAIMS-MADE 7930021230000 05I0112014 051011207$ AGGREGATE $ 2,000,00 'ED X RETENTIONS 0, 1 $ WORKERS COMPENSATION X PER OTH- ANDEMPLOYERS'UABILJTY STATUTE ER NIA 032521528 05I01I2074 0510112015 EL EACH ACCIDENT E 1,000,00 C ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICERMEMBER EXCLUDED? (Mandatory In NH) E. L, DISEASE-EA EMPLOYEE $ 1,000,00 U describe order RIPTION OF OPERATIONS be. El DISEASEPOLICY LIMIT S 1,800,88 D Work Comp Other Stat WC959746703 05101/2014 06/0112015 $1,000,0001$1,000,00 1,000,00 A Professional and 7930021220000 05/01/2014 0510112015 Pollution Coverage 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be aaached B more space Is required) Proprietors/Partners/Executive Officers/Members Excluded: Liz Dykstra, Secretary/Treasurer Primary and Non-Contributory Blanket Additional Insured perform OBENVGE319. Waiver of Subrogation applies perform OBENVGE320. Auto Blanket Additional Insured and Waiver per form VCA625LA 02 12. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ashland Water Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 90 N. Mountain Avenue Ashland, OR 97520 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD