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HomeMy WebLinkAboutInsurance Certificate: Pierce Manufacturing Inc ® DATE (MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 09/26/2014 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 1-414-443-0000 CONTACT NAME: Hays Companies of Wisconsin, Inc. PHONE FAX N Ex : A/C No): 1200 North Mayfair Road, Suite 100 ADDRESS: Milwaukee, WI 53226 INSURERS AFFORDING COVERAGE NAIC# _ INSURER A: NATIONAL FIRE & MARINE INS CO 20079 INSURED INSURER B: TRAVELERS PROPERTY CAS CO OF AMER 25674 Pierce Manufacturing Inc. INSURER C: PHOENIX INS CO 25623 P.O. Box 2017 INSURER D: BERKLEY NATL INS CO 38911 Appleton, WI 54912-2017 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: 41592886 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. _ POLICY I LTR NSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM DD/YEYYY MM DD/YYYY LIMITS A GENERAL LIABILITY X 42-GLO-100190-01 04/01/1 04/01/15 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 500, 000 CLAIMS-MADE 1XI OCCUR MED EXP (Any one person) $ Excluded PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OPAGG $ 1,000,000 X POLICY PRO LOC $ B AUTOMOBILE LIABILITY TJCAP118D2004TIL14 10/01/14 10/01/15 COMBINED SINGLE LIMIT Ea accident 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED L SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS - NON-OWNED PROPERTY DAMAGE $ Per accident HIRED AUTOS AUTOS A X UMBRELLA LIAB X OCCUR 42-UMO-100191-01 04/01/1 04/01/15 EACH-OCCURRENCE $ 15,000,000 EXCESS LIAB F_ICLAIMS-MADE AGGREGATE _ $ 15,000, 000 DED RETENTION $ $ B WORKERS COMPENSATION TRJUB117D757714 10/01/1 10/01/15 X WCSTATU- OTH- - AND EMPLOYERS' LIABILITY C ANY PROPRIETOR/PARTNER/EXECUTIVE TC2NUB117D756514 10/01/1 10/01/15 E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E.L. DISEASE- EA EMPLOYE $ 1, 000, 000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 D Excess Liability CEX0960017401 04/01/1 04/01/15 Ea Occ/Agg 10,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Additional Insured when required by written contract. Two (2) Pierce Dash CF 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 94 USA ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD diannewandel 41592886 F Nays MEMORANDUM Hays Companies 1200 N. Mayfair Road, Suite 100 Milwaukee, WI 53226 414.443.0000 414-259-8448 Fax www.hayscompanies.com Date: September 26, 2014 To: Pierce Manufacturing, Inc. Certificate Holders Regarding: Certificate term 10/01/2014 - 10/01/2015 The Commercial Automobile and Workers' Compensation coverages for Pierce Manufacturing, Inc. have been renewed effective 10/01/2014. Because you were sent a certificate during the previous policy term, you are receiving this certificate which reflects their policy information as of 10/01/2014. If you no longer require this certificate, we would appreciate it if you would let us know by emailing Renee Hitter or Dianne Wandel at RHitter(a)-hayscomPanies.com or DWandel(c~hayscompanies.com with a copy of the certificate and a note advising us to remove you from the certificate distribution list for Pierce Manufacturing. If you have any questions regarding this, please contact me. Sincerely, Renee Hitter Account Representative Hays Companies Direct line: 414-290-3629 Email: Rhitter(d-)hayscompanies.com Dianne Wandel Account Administrator Hays Companies Direct line: 414-290-3585 Email: DWandel(a)-hayscompanies.com