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HomeMy WebLinkAboutInsurance Certificate: Devon Pereira 0 DATE (MM/DD/YYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE 1 F03/24/2015 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(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 NAME: Marsh Sponsored Programs PHONE 800-338-1391 AJC A/C No Ext No, 888-621-31"73 a division of Marsh USA Inc. E-MAIL 701 Market Street, Ste. 1100 St. Louis MO 63101 INSURER(S AFFORDING COVERAGE NAIC# INSURERA:Sentinel Insurance Company Ltd 11000 INSURED INSURER B: Hartford Casualty Insurance Company 29424 B Devon Pereira INSURER C: 920 Country Club Road INSURER D: Eugene, OR 97401-2231 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. AD DL -SUM POLICY EFF POLICY EXP ILTNSR R TYPE OF INSURANCE IN WVD POLICY NUMBER MMIDD/YYY MWDDIYYYY LIMITS A GENERAL LIABILITY y 84SBWPA4035 03/20/2015 03/20/2016 EACHOCCURRENCE $2,000,000 X COMMERCIAL GENERAL LIABILITY Prof. Liab. Excl. OAMAGETORENTED - $2,000,000 CLAIMS-MADE U OCCUR PREMISES (Ea occurrence) MED EXP (Any one person) $10, 000 PERSONAL & ADV INJURY $2,000,000 GENERAL AGGREGATE $4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMPIOP AGG $4,000,000 POLICY X jRCOf LOC $ A AUTOMOBILE LIABILITY Y 84UEGPF0127 03/20/2015 03/20/2016 COMBINED SINGLE LIMIT Eaaccident $2 000 000 ANY AUTO BODILY INJURY (Per person) $ X ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS H NON-OWNED PROPERTY DAMAGE $ Per accident HIRED AUTOS AUTOS $ B y, UMBRELLA LIAB X OCCUR 84XHGYH1723 03/20/2015 03/20/2016 EACH OCCURRENCE $5,000,000 EXCESSLIAB CLAIMS-MADE AGGREGATE s5,000,000 DED RETENTION$ 10, 000 $ A WORKERS COMPENSATION 84WBGBJ0746 03/20/2015 03/20/2016 X WCSTATU- OTH- TORY LIMITS ER AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE~ NIA E.L. EACH ACCIDENT $1,000,000 OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE - EA EMPLOYE $1,000,000 DESCr E.L. DISEASE- POLICY LIMIT $1, 000, 000 If yes, describeRIPTION OF unde OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Project: ARRA Project No.2007-17, Oak-Ann street section (Hersey Street Sidewalk Reconstruction) - City of Ashland is included as additional insured for above coverages except WC as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CITY OF ASHLAND AUTHOOR,IZZE"REPRESENTATIVE 51 WINBURN WAY ASHLAND, OR 97520 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD