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HomeMy WebLinkAboutInsurance Certificate: Pierce Manufacturing Inc 3/23/ /2D01D/YYYY) '``~°RO® CERTIFICATE OF LIABILITY INSURANCE 0DATE (MMJ 03/25 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 1-414-443-0000 CONTACT Hays Companies of Wisconsin, Inc. PHONE FAX E AIC No : 1200 North Mayfair Road, Suite 100 E-MAIL ADDRESS: Milwaukee, WI 53226 INSURERS AFFORDINGCOVERAGE NAIC# INSURER A: NATIONAL FIRE & MARINE INS CO 20079 INSURED INSURERB: TRAVELERS PROPERTY CAS CO OF AMER 25674 Pierce Manufacturing Inc. INSURER C: PHOENIX INS CO 25623 P.O. Box 2017 INSURER D: BERKLEY NATL INS CO 38911 Appleton, WI 54912-2017 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: 43328051 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MMIDD/YYYY LIMITS A GENERAL LIABILITY X 42-GLO-100190-01 04/01/1 04/01/16 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREM SE S( OEa occTur ence $ 500,000 CLAIMS-MADE OCCUR MED EXP (Any one person) $ Excluded PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OPAGG $ 1,000,000 X POLICY PRO LOC $ B AUTOMOBILE LIABILITY TJCAP118D2004TIL14 10/01/1 10/01/15 COMBINED SINGLE LIMIT Ea accident 1, 000, 000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ A X UMBRELLA LIAB X OCCUR 42-UMO-100191-01 04/01/1 04/01/16 EACH OCCURRENCE $ 15,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $ 15, 000, 000 DED RETENTION $ $ B WORKERS COMPENSATION TRJUB117D757714 10/01/1 10/01/15 X WCSTATU- OTH- AND EMPLOYERS' LIABILITY Y / N T I ER C ANY PROPRIETOR/PARTNER/EXEC. I- I-~ TC2 NUB 117D756514 10/01/1 10/01/15 E.L. EACH ACCIDENT $ 1,000,000 OFPICERMEMBER EXCLUDED? I N/A (Mandatory in NH) E.L. DISEASE -_EA EMPLOYE $ 1, 000, 000 If yes, describe under E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below 1, 000, 000 D Excess Li i ity CEX Ea Occ Agg 10,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Additional Insured when required by written contract. Two (2) Pierce Dash CF Pumpers CERTIFICATE HOLDER CANCELLATION 27255-1-2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 90 North Mountain Avenue AUTHORIZED REPRESENTATIVE Ashland, OR 97520 USA •v nB Q~ © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD diannewandel 43328051