HomeMy WebLinkAboutInsurance Certificate: Perrine Industrial Electricians Inc
9PERREL OP ID: PB
ACORN- CERTIFICATE OP LIABILITY INSURANCE 707;281201MM/DD/YYYY)
4
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 Phone: 541-779-4232 NCONTACT
AME:
Hart Insurance Fax: 541-772-3963 PHONE FAX
1123 Royal Ave. A/c N. Ext : A/c No :
Medford, OR 97504 E-MAIL
Hart Insurance / Medford ADDRESS:
INSURERS AFFORDING COVERAGE NAIC #
INSURER A: American Hallmark Ins Co of TX 43494
INSURED Perrine Industrial INSURERB:
Electricians Inc.
6067 Crater Lake Hwy INSURER C
Central Point, OR 97502 INSURER D:
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.
INSR A
TYPE OF INSURANCE POLICY NUMBER MM/ DNYYY MM/DD//YYYY LIMITS
LTR
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00
A X COMMERCIAL GENERAL LIABILITY X 44CL477531 12/22/2014 12/2212015 PAMAGE To RENTED
Ea occurrence $ 100,00
CLAIMS-MADE FKOCCUR MED EXP (Any one person) $ 5,00
PERSONAL & ADV INJURY $ 1,000,00
GENERAL AGGREGATE $ 2,000,00
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00
X POLICY jPERC0j F-] LOC Emp Ben. $ 1,000,00
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1 000 00
Ea accident $ ,
A ANY AUTO 44CL477531 12/22/2014 12/22/2015 BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS Ix AUTOS
NON-OWNED PROPERAMAGE $
X HIRED AUTOS AUTOS Per accident
X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00
A EXCESS LIAB CLAIMS-MADE 44CU477532 12/22/2014 12/22/2015 AGGREGATE $ 1,000,00
DED X RETENTION $ 10,000 $
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? F-] N / A
(Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
certificate holder is listed as additional insured per attached form MP9767
10/10
CERTIFICATE HOLDER CANCELLATION
ASHLAI
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.
20 E Main Street
Ashland, OR 97520 AUTHORIZ REPRESENTATNE
Hart I ranc Medf
01988-2010 ACO ORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
General Liability Additional Coverages
The following Additional Coverages are added to the COMMERCIAL GENERAL LIABILITY COVERAGE FORM.
A. Blanket Additional Insured Coverage
1. SECTION II - WHO IS AN INSURED of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM is amended
to include as an insured any person or organization (referred to as Additional Insured) whom you are required to add
as an Additional Insured on this policy under:
a. A written contract or agreement; and
b. Where a certificate of insurance showing that person or organization as an additional insured has been issued
c. When the written contract or agreement and certificate of insurance are currently in effect or becoming in effect
during the term of the policy and executed prior to the "bodily injury," "property damage," or "personal and advertising
injury."
2. The insurance provided to the Additional Insured is limited as follows:
a. The Additional Insured is only an additional insured for:
(1) "Bodily injury," "property damage," or "personal and advertising injury" caused in whole or in part by negligent acts
or omissions of the Named Insured or anyone directly or indirectly employed by the Named Insured or for whose acts
a Named Insured may be liable.
(2) Liability arising out of your ongoing operations for the Additional Insured by or for you. A person's or organization's
status as an insured under this coverage ends when your operations for that insured are completed.
b. The Limits of Insurance applicable to the Additional Insured are those specified in the written contract or
agreement but not more than the Limits of Insurance specified in the Declarations for this policy. The Limits of
Insurance applicable to the Additional Insured are inclusive of and not in addition to the Limits of Insurance shown in
the Declarations for the Named Insured.
3. In addition to the other exclusions applicable to Section 1, Coverages A., B. and C. of the
COMMERCIAL GENERAL LIABILITY COVERAGE FORM, the insurance provided to the Additional Insured does not
apply to:
a. "Property damage" to:
(1) Property owned, used, occupied by, loaned or rented to the Additional Insured;
(2) Property in the care, custody or control of the Additional Insured or over which the Additional Insured are for any
purpose exercising physical control; or
(3) "Your work" performed for the Additional Insured.
b. "Bodily injury," "property damage," or "personal and advertising injury" arising out of an architect's, engineer's or
surveyor's rendering or failure to render any professional services for you, for the Additional Insured or for others,
including, but not limited to:
(1) The preparing, approving or failure to prepare or approve maps, drawings, opinions, reports, surveys, change
orders, designs or specifications; or
(2) Supervisory, inspection or engineering services.
c. "Bodily injury" or "property damage" occurring after:
(1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than
service, maintenance or repairs) to be performed by or on behalf of the additional insured at the site of the covered
operations has been completed; or
(2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any
person or organization other than another contractor or subcontractor engaged in performing operations for a
principal as a part of the same project.
4. SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, Paragraph 4. Other Insurance, is amended to
add the following subparagraph:
d. Additional Insured's Other Insurance As Excess Insurance
To the extent required by an "insured contract," this insurance is primary on behalf of the Additional Insured; and any
other insurance maintained by the Additional Insured is excess and not contributory with this insurance. If the
"insured contract" does not require this provision, then Paragraph a. above will apply.
B. Mobile Equipment Broadened Coverage
V.12.f.(1) of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM is replaced by the following:
(1) Equipment designed primarily for:
(a) Snow Removal;
(b) Road maintenance, but not construction or resurfacing; or
(c) Street cleaning.
Except the above provisions do not apply to self-propelled vehicles of less than 1,000 pounds gross vehicle weight
which are not intended for use on a highway.
C. Aggregate Limit Per Project
MP 97 67 10 10 Includes copyrighted material of Insurance Services Office, Inc. and Page 1 of 2
American Association of Insurance Services, Inc., with their permission
The General Aggregate Limit under SECTION III - LIMITS OF INSURANCE of the COMMERCIAL GENERAL
LIABILITY COVERAGE FORM applies separately to each of your projects away from premises owned by or rented to
you. Page 22 of 25 Includes copyrighted material of Insurance Services Office, Inc. and MP 97 67 1010 American
Association of Insurance Services, Inc., with their permission D. Blanket Waiver Of Transfer Of Rights Of Recovery
Against Others To Us
The Transfer Of Rights Of Recovery Against Others To Us Condition (SECTION IV - COMMERCIAL GENERAL
LIABILITY CONDITIONS) is amended by the addition of the following:
We waive any right of recovery we may have against any person or organization to whom you by written contract or
written agreement have waived your own right or recovery for loss caused by that person or organization because of
payments we make for injury or damage arising out of your ongoing operations or "your work" done under a written
contract or written agreement with that person or organization and included in the "products-completed operations
hazard."
This provision does not apply unless the written contract or written agreement has been executed prior to the
"occurrence" or offense giving rise to the "bodily injury" or "property damage."
E. Voluntary Property Damage Coverage
1. We will, at your request, pay but not defend any claim for "property damage" to the property of others otherwise
excluded under A.2.j.(4), (5) and (6) of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM provided that:
a. Such "property damage" takes place while such property is in your care, custody or control, or is property of others
over which you, for any purpose, are exercising or have exercised physical control; and
b. Such "property damage" takes place away from any premises you own, rent or lease; and
c. Such "property damage" takes place within the "coverage territory" and during the policy term; and
d. Such "property damage" takes place only during your operations that are known to us, are scheduled on the policy
and for which a premium has been charged.
2. The insurance under this additional coverage does not apply to "property damage" to property:
a. Held by you for servicing, repair, storage or sale at premises owned by, rented or leased to you;
b. While being transported by or caused by the ownership, maintenance, operation, use, "loading or unloading" of any
"auto," watercraft or aircraft; or
c. Owned or occupied by or rented to you.
3. Deductible This additional coverage will apply only to that amount of any loss in each "occurrence" that exceeds
$500. The terms of the policy with respect to your duties in the event of "occurrence," claim or "suit" and the
Company's right to investigate, negotiate and settle any claim or "suit" apply irrespective of the application of the
deductible amount of $500.
We may pay any part or all of the deductible amount of $500 to effect settlement of any claim or "suit." Upon
notification of the action taken, you must promptly reimburse us for such part of the deductible amount as has been
paid by us.
4. Limits of Liability
The Limit of Liability for this additional coverage shall not exceed $2,500 for each "occurrence" and is the limit of the
Company's liability for all damages on account of each claim or "suit" covered herein. The annual aggregate Limit of
Liability is $2,500 and is, subject to the above provisions respecting each claim, the total limit of the Company's
liability for all damages.
5. Settlement
In the event of loss covered by this additional coverage, you shall, if requested by us, replace the property or furnish
the labor and materials necessary for repairs thereto at actual cost to you, excluding prospective profit or overhead
charges of any nature. Any property so paid for or replaced shall, at our option, become the property of the Company.
Payment hereunder shall not constitute an admission of liability of you or, except as stated herein, of the Company.
MP 97 67 10 10 Includes copyrighted material of Insurance Services Office, Inc. and Page 2 of 2
American Association of Insurance Services, Inc., with their permission