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HomeMy WebLinkAboutInsurance Certificate: Engineered Monitoring Solutions LLC A °R" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/OOIYYYY) 12/4/2014 THIS CERTIFICATE 18 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()es) 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 NAME: CT Dee Hughes Slater 6 Associates Insurance, Inc PHONE (503) 624-0466 FAX (503) 624-0846 lop PC Fxtl- AC. Not: PO Box 1469 F-MAIL ADDRESS; Tualatin, OR 97062-1469 INSURER(S) AFFORDING COVERAGE NAIC0 INSURER A .SAIF Co 6196 INSURED INSURER 8: Engineered Monitoring Solutions LLC INSURERC: 617 N Main St INSURER D : Newberg, OR 97132 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. INS POLICY EFF POLICY EXP LIMITS ADDLSUBR TYPE OF INSURANCE POLICY NUMBER GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTFU_ S COMMERCIAL GENERAL LIABILITY PREMISES e occurrenol CLAIMS-MADE r-1 OCCUR MED EXP (Arty one person) S PERSONAL 8 ADV INJURY b GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OPAGG $ POLICY PRO- LOC $ -I E-1 r F AUTOMOBILE LIABILITY Co BIN D SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) S AUTOS AUTOS NON-OWNED PROPERTY DAMAGE S HIRED AUTOS AUTOS Per accideryt) S UMBRELLA LIAR OCCUR EACH OCCURRENCE S R EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS $ A WORKERS COMPENSATION X VJC STATU- "MIT, EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE ~ N/A E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED9 958900 2/1/2014 2/1/2015 (Mandatory In NH) E.L. DISEASE - EA EMPLOYS $ 1 000 000 If yes, describe under DESCRIPTION OF OPERATIONS blow E.L DISEASE -POLICY LIMIT S 1 000 000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION (541) 488-5320 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF ASHLAND ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Rob Morris 20 E Main St AUTHORIZED REPRESENTATIVE Ashland, OR 97520 Dee Hughes/DMH ACORD 25 (2010105) ®1988-2010 ACORD CORPORATION. All rights reserved. INS025 (201005).O1 The ACORD name and logo are registered marks of ACORD A I°® CERTIFICATE OF LIABILITY INSURANCE DATE (MWDDJYYYY) 12/03/2014 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 endorsements . PRODUCER NCONTACT AME: Slater&Associates Insurance Mid Valley General Agency LLC PHONE 503.624.0466 ac No : 503.624.0846 LAM Yo C-MAIL 4305 River Road N. ADDRESS: dee@slaterinsurance.com INSURERS AFFORDING COVERAGE NAIC I Keizer OR 97303 INSURER A: Scottsdale Insurance Company 41297 INSURED INSURER B : Engineered Monitoring Solutions LLC INSURERC: 617 N Main St INSURER D: INSURERS: Newberg OR 97132 WSURERF: 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 TYPE OF INSURANCE POLICYNUMBER MMIODIYYYY (MMIDDNYYY) LIMITS GENERALLIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTLff- $ 100,000 X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE FXIOCCUR MED EXP An one erson S 5,000 A Y CPS2103067 12103/2014 12/03/2015 PERSONAL & AOV INJURY $ 1,000,000 GENERAL AGGREGATE S 2,000.000 G N'LAGGREGATELIMITAPPLIESPER: PRODUCTS -COMPIOPAGG S 2,000,000 PRO- LOC S X POLICY F_] JFCT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT a ca enl ANY AUTO BODILY INJURY (Par person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) S AUTOS AUTOS NON-OWNED Per PERTnl S HIREDAUTOS AUTOS 3 UMBRELLA LIAB HOCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE S DEO RETENTION S $ WORKERS COMPENSATION VJC STATU- OTH- AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTIVE IA E.L. EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? N IN (Mandatoryto NH) E.L. DISEASE - EA EMPLOYE If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Addltlonal Remarks Schedule, If more space Is roqulrod) City of Ashland Is Included as additional Insured per GLS-150s (07/06). CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 E Main St ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE Ashland OR 97520 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010106) The ACORD name and logo are registered marks of ACORD Here are Certificates of Insurance. Dee Hughes dee@slaterinsurance.com Slater & Associates Insurance, Inc. PO Box 1469, Tualatin, OR 97062 (503)624-0466 x216 (503)624-0846 Fax www.slaterinsurance.com ENDORSEMENT NO. ATTACHED TO AND ENDORSEMENT EFFECTIVE DATE FORMING A PART OF 11 01 A.M. STANDARD TIME) NAMED INSURED AGENT NO. POLICY NUMBER CPS2103897 12/03/2014 ENGINEERED MONITORING SOLUTIONS LLC 36005 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART With respect to this endorsement, SECTION II-WHO IS a. All work, including materials, parts or equip- AN INSURED is amended to include as an additional in- ment furnished in connection with such work, sured any person or organization whom you are required to on the project (other than service, mainten- add as an additional insured on this policy under a written ance or repairs) to be performed by or on be- contract, written agreement or written permit which must be: half of the additional insured(s) at the location a. Currently in effect or becoming effective during of the plated; or covered operations has been com- the term of the policy; and b. Executed prior to the "bodily injury," "property b. That portion of "your work" out of which the in- damage," or "personal and advertising injury." jury or damage arises has been put to its in- tended use by any person or organization The insurance provided to these additional insureds is li- other than another contractor or subcontrac- mited as follows: for engaged in performing operations for a 1. That person or organization is an additional insured principal as a part of the same project. only with respect to liability for "bodily injury," 3. The limits of Insurance applicable to the additional "property damage" or "personal and advertising insured are those specified in the written contract, injury" caused, in whole or in part, by: written agreement or written permit or in the Decla- rations for this policy, whichever is less. These lim- a. Your acts or omissions; or its of insurance are inclusive of, and not in addition b. The acts or omissions of those acting on your to, the Limits of Insurance shown in the Declara- behalf. tions for this policy. A person's or organization's status as an addi- 4. Coverage is not provided for 'bodily injury," tional insured under this endorsement ends when "property damage," or 'personal and advertising your operations for that additional Insured are injury" arising out of the sole negligence of the completed. additional insured. 2. With respect to the insurance afforded to these S. The insurance provided to the additional insured additional insureds, the following exclusions are does not apply to "bodily injury," "property damage." added to item 2. Exclusions of SECTION 11- or "personal and advertising injury" arising out of COVERAGES: an architect's, engineer's or surveyor's rendering of or failure to render any professional services This insurance does not apply to 'bodily injury," including: "property damage" or "personal and advertising injury" occurring after: Includes copyrighted material of ISO Properties, Inc., with its permission. Copyright, ISO Properties, Inc., 2004 GLS-150s (7-06) Page 1 of 2 a. The preparing, approving or failing to prepare written contract specifically requires that this insur- or approve maps, shop drawings, opinions, re- ance be primary. ports, surveys, field orders, change orders or drawings and specifications; and When this insurance is excess, we will have no du- ty under SECTION I-COVERAGES to defend the b. Supervisory, Inspection, architectural or engi- additional insured against any "suit' if any other in- neering activities. surer has a duty to defend the additional insured 6. Any coverage provided hereunder will be excess against that 'suit.' If no other insurer defends, we over any other valid and collectible Insurance avail- will undertake to do so, but we will be entitled to the able to the additional insured whether primary, additional Insured's rights against all those other excess, contingent or on any other basis unless a insurers. AUTHORIZED REPRESENTATIVE DATE Includes copyrighted material or ISO Properties, [no-, with its permission. Copyright, ISO Properties, Inc., 2004 GLS-150s (7-06) Page 2 of 2