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HomeMy WebLinkAboutInsurance Certificate: Industrial Systems Inc A`~ CERTIFICATE OF LIABILITY INSURANCE F X12/2015YYY, 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 Employee DEFREP NAME: I FAX N C. (503)292-1580 American Benefits Inc. PHONE No:(503)467-4600 9755 SW Barnes Rd E-MAIL Suite 290 INSURERS AFFORDING COVERAGE NAIC # Portland OR 97225 INSURERA:Libe - Liberty Northwest 41939 INSURED INSURERB:Hartford Accident And Indemnit 2357 Industrial Systems, Inc. INSURERC:Indl - Admiral Insurance 5835 NE 122nd AVENUE #110 INSURER D: INSURER E : Portland OR 97230 INSURER F : COVERAGES CERTIFICATE NUMBER:CL151200746 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 ADDLUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/ D/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED 2,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ A CLAIMS-MADE Fx_1OCCUR ZS54620179 1/1/2015 1/1/2016 MED EXP (Any one person) $ 15,000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 4,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ A ALL OWNED SCHEDULED ASS4620179 1/1/2015 1/1/2016 AUTOS AUTOS BODILY INJURY (Per accident) $ X HIRED AUTOS X NON-OWNED Pe a cidTY DAMAGE $ AUTOS X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DED X RETENTION$ 10,00 S054620179 1/1/2015 1/1/2016 $ B WORKERS COMPENSATION WC STATU- DTH- AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE N E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? N/A 2WECLR7227 11/1/2014 1/1/2015 (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ 1,000,000 It yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 C Professional Liability 0000021111101 11/12/2014 1/12/2015 $1,000,000 A Business interruption ZS54620179 1/1/2015 1/1/2016 12 Months ALS DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Certificate Holder is named as an Additional Insured with respects to the liability arising from the operations of the Named Insured. The Certificate Holder is an Additional Insured per insurance policy provisions. CERTIFICATE HOLDER ILLATION n I D ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE U E XPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland DANCE WITH THE POLICY PROVISIONS. 20 East Main street 5 2015 Ashland, OR 97309 A D REPRESENTATIVE -1 too Jim H' atomi/KATG [ ` ACORD 25 (2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 (201005).01 The ACORD name and logo are registered marks of ACORD