HomeMy WebLinkAboutInsurance Certificate: Modular Space Corporation (2)
A CERTIFICATE OF LIABILITY INSURANCE Page 1 of 1 DATE 2g Z
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
Willis of Pennaylvenia, Inc. PRONE FA%
C/o 26 Century Blvd. 877-945-7378 888-467-2378
P. O. Box 305191 E-MAIL certificates@willis.com
Nashville, TN 37230-5191 AnDRFqR INSURER S)AFFORDING COVERAGE NAICk
INSURERA: Zurich American Insurance Company 16535-006
INSURED Modular Space Corporation INSURERS: American Guarantee & Liability Insurance 26247-005
1200 Swedesford Road INSURERC:
Berwyn, PA 19312-1075
INSURER D:
INSURER E:
INSURERF:
COVERAGES CERTIFICATE NUMBER: 21378934 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 ANYREGUIREMENT, 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 TYPE OFINSURANCE DD' SUB pOUCY NUMBER POUCYEFF POUCYEXP LIMES immmno= A GENERALUABILm GLO 5747082 07 /30/2014 3/30/2015 EACH OCCURRENCE Is
1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
PREMISES Ea omurerce $ 300.000
CLAIMS-MADEa OCCUR MEDEXP(Anyone rson) S 10,000
PERSONAL&ADV INJURY $ 1.000.000
GENERALAGGREGATE $ 2.000.000
GEN'LAGGREGATE UMITAPPUES PER: PRODUCTS -COMPJOPAGG $ 2 000 000
X POLICY PRO LOC
$
A AUTO MOBILE UABILrrv BAP 5747081 01 /30/2014 3/30/2015 (EOMaB~I agMSINGLE LIMIT
$ 2,000,000
X ANY AUTO BODILY INJURY(Per person) S
ALLOWNED SCHEDULED
AUTOS AUTOS BODILY INJURV(ParaccitleM) $
X HIREDAUTOS $ NON-OWNED AA 7RC AUTOS IF,, axident $
B X UMBRELLALIAB X OCCUR AUC 5747218-01 /30/2014 3/30/2015 EACHOCCURRENCE $ 51000,000
IXCESS me CLAIMS-MADE AGGREGATE $ 5 000 000
DED RETENTIONS $
JOTM
A WORKERS COMPENSATION WC 5747083 Ol /30/2014 3/30/2015 X W
AND EMPLOYERS' LIABILITY Y/N
A ANY PROPRIETORIPARTNEREXECUTWE N❑ NSA WC 5747084 Ol /30/2014 3/30/2015 E.LEACHACCIDENT E 11000,000
OFFICERIMEMBER EXCLUDED?
rAanda:sy,in NH) E.L DISEASE-EA EMPLOYEE $ 1,000,000
I yyes, desdibe under
.DESCRIPIONOFOPERATIONSbelow E.L. DISEASE-POLICY uMIT S 1,000,000
DESCRIPTION OF OPERATIONSI LOCATIONS/ VEHICLES (Attach Amrd 101, Additonal Remarks Schedule, if more span I. requlred)
Re: Lease #190179
Subject to their terms and conditions, the above referenced liability policies (excluding Workers'
Compensation and Employers Liability) include Ashland Parks and Recreation as Additional Insured in
regards to work performed by employees, agents and subcontractors of MSC in the course of
delivering, installing, repairing and/or removal of modular buildings leased or purchased from MSC.
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.
Ashland Parks and Recreation AUTHORIZED REPRESENTATIVE
Attn: Xari Olson
90 N. Mountain Ave.'
Ashland, OR 97520
Coll:4375520 Tpl:1788931 Cert:21378934 01988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD