Loading...
HomeMy WebLinkAboutInsurance Certificate: HazmatiQ (2) 186023 AC-~ ® DATE (MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 2/18/2015 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(les) must be endGrsed. 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 NAME: Debbie Archimbaud - - Commercial Lines - (919) 676-8834 PHONt= _t FAX (A/c, Ng E:t~ 919-334-2605 - - 1 A/C, No):. _ _ Wells Fargo Insurance Services USA, Inc. E-MAIL - - ADDRESS: debbie.archimbaud@wellsfargo.com 8540 Colonnade Center Drive, Suite 111 INSURER(S) AFFORDING COVERAGE NAIL Raleigh, NC 27615 INSURER A: Great Northern Insurance Company 20303 INSURED INSURER B : Federal Insurance Company 20281 HazmatlQ by Federal Resources INSURER C: Indian Harbor Insurance Company 36940 235-G Log Canoe Circle INSURER D : INSURER E Stevensville MD 21666 INSURER F : COVERAGES CERTIFICATE NUMBER: 8739270 REVISION NUMBER: See below 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 TYPE OF INSURANCE ADDL SUBRI POLICY EFF- POLICY EXP - LIMITS LTR I D D POLICY NUMBER MMIDD/YYYY MM/DDIYYYY X COMMERCIAL GENERAL LIABILITY 35894855 02/16/2015 1,000,000 02/16/2016 i EACH OCCURRENCE DAMAGE TO RENTED CLAIMS-MADE X - A I - _I OCCUR PREMISES (Ea occurrence) 1,000,000 MED EXP (Any one person). $ 10,000 PERSONAL & ADV INJURY $ 1 000,000 _ ~G__E_N'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 X I POLICY 1-1 JECOT l 1 LOC - 2 000,000 PRODUCTS COMP/op AGG OTHER: $ A AUTOMOBILE LIABILITY 73587445 02/16/2015 02/16/2016 COMBINED SINGLE LIMIT $ 1 ,000,000 CEa accident) f I X I ANY AUTO BODILY INJURY (Per p.,rson) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accdent) $ NON-OWNED - PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident - $ - B X UMBRELLA LIAB X OCCUR 79832965 02/16/2015 02/16/2016 EACH OCCURRENCE $ ________1-00Q000____ EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N 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 $ C ,Professional Liability MTP0041276 02/1612015 02/16/2016 $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) The City of Ashland, Oregon is included as additional insured for General Liability, Automobile Liability, and Professional Liability as their interest may appear as required by written contract. Coverage is primary and non-contributory. CERTIFICATE HOLDER CANCELLATION The City of Ashford, Oregon SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 East Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE The ACORD name and logo are registered marks of ACORD ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) 11111111111111111111111111111111111111111111111111111111 IIII) VIII 1111111111111111111111111111 •CYB01A18/0004021021021010/0/0' Commercial Lines - (919) 676-8834 Wells Fargo Insurance Services USA, Inc. 8540 Colonnade Center Drive, Suite 111 Raleigh, NC 27615 The City of Ashford, Oregon 20 East Main Street Ashland, OR 97520 Would you like to receive this certificate via email or fax? We offer expedited delivery to better serve our mutual clients. To update the delivery method for revisions to this certificate and for next year's copy, please enter this information in your browser: https://www.cybersure.com/cybersure/forms/iyoc/cdmu.aspx When prompted, enter this information for security purposes: Client ID: 186023 Cert ID: 8739270 Passcode: 5E6E55EA Follow the instructions and let us know your delivery preference. You'll receive future copies of this certificate via the method you provide. Thank you for helping us provide certificates to you more quickly. **,r***+***xw* W,r• W *******+**,tr*x*+*,+w**w~„r* *,r~*r,r* r*,r**,r,t**«r~~~*r~~r*,r~~,r*~r,t,r***,r*******,r*+*,r**w,t,t*~~+~,rt*,r,r*,r~**** 1111111111111111111 IN 11111111111111111111111111111111111111111111111111111111111111111111 'CYBOW81000402/01/02/0/01010'