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HomeMy WebLinkAboutInsurance Certificate: Modular Space Corporation A CERTIFICATE OF LIABILITY INSURANCE Pag DATE (MM1DDNY e 1 of 1 03/31/205 / / 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: Willis of Pennsylvania, Inc. PHONE FAX C/o 26 Century Blvd. A/C NO EXT: 877-945-7378 A/C NO: 888-467-2378 P. O. Box 305191 E-MAIL Nashville, TN 37230-5191 ADDRESS: certificates@willis.com INSURER(S)AFFORDING COVERAGE NAIC # INSURERA:Zurich American Insurance Company 16535-006 INSURED Modular Space Corporation INSURER B: Continental Casualty Company 20443-001 1200 Swedesford Road INSURER C: Berwyn, PA 19312-1078 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 23007957 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 TYPE OF INSURANCE DDL SUB POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR IN SD WVD M DD/YYYY MM/DD YYY A X COMMERCIAL GENERAL LIABILITY GLO 5747082 02 3/30/2015 3/30/2016 EACHOCCURRENCE $ 1 000 000 _7 RpAqW~qRGE TT D~ENTED CLAIMS-MADE X OCCUR PREM(SES~Ea occurence) $ 300,000 MED EXP (Anyone person) $ 10,000 PERSONAL& ADV I NJU RY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2 0 00,000 X POLICY [7 PRO- F LOC JECT PRODUCTS COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY BAP 5747081 02 3/30/2015 3/30/2016 COMBINED SINGLE LIMIT 2,000,000 (Ea accident) $ X ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident $ $ B X UMBRELLA LIAB X OCCUR L6011986371 3/30/2015 3/30/2016 EACHOCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION $ $ A WORKERS COMPENSATION WC 5747083 02 3/30/2015 3/30/2016 X PER TH AND EMPLOYERS' LIABILITY STATUTE ER A ANY PROPRIETOR/PARTNER/EXECUTIVEY~ N/A WC 5747084 02 3/30/2015 3/30/2016 E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ~Mandatory in NH' E.L. DISEASE - EA EMPLOYEE $ 1,000,000 f yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additonal Remarks Schedule, may be attached if more space is required) Re: Lease #190179 Subject to their terms and conditions, the above referenced liability policies (excluding Workers' Compensation and Employers Liability) include Ashland Parks and Recreation as Additional Insured in regards to work performed by employees, agents and subcontractors of MSC in the course of delivering, installing, repairing and/or removal of modular buildings leased or purchased from MSC. 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. Ashland Parks and Recreation AUTHORIZED REPRESENTATIVE Attn: Kari Olson 90 N. Mountain Ave. Ashland, OR 97520 Coll:4656980 Tpl:1938603 Cert:23007957 ©1988-2014ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD ACQ ® DATE (MM/DD/YYYY) ~ CERTIFICATE OF LIABILITY INSURANCE page 1 of 1 03/31/2015 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- Willis of Pennsylvania, Inc. PHONE FAX c/o 26 Century Blvd. - 877-945-7378 888-467-2378 P. O. Box 305191 E ADDRESS- -MAIL certificates@willis.com Nashville, TN 37230-5191 INSURER(S)AFFORDINGOOVERAGE NAIC # INSURERA:Zurich American Insurance Company 16535-006 INSURED Modular Space Corporation INSURER B. Continental Casualty Company 20443-001 1200 Swedesford Road INSURER C. Berwyn, PA 19312-1078 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 23007957 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 TYPE OF INSURANCE IN-,;n WVD DDL SUB POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR A X COMMERCIAL GENERAL LIABILITY GLO 5 7 4 7 0 8 2 02 3/30/2015 3/30/2016 EACH OCCURRENCE $ 11000,000 DDAM~AA EE JTV oNcurD $ 300,000 CLAIMS-MADE X OCCUR P~EMES (t ) MED EXP (Any one person) $ 10, 000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 F1 PRO- POLICY JECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY BAP 5747081 02 3/30/2015 3/30/2016 COMBINED SINGLE LIMIT 2,000,000 (Ea accident) $ X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) $ B X UMBRELLA LIAB X OCCUR L6011986371 3/30/2015 3/30/2016 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5 000, 000 DED RETENTION $ $ A WORKERS COMPENSATION WC 5747083 02 3/30/2015 3/30/2016 X H AND EMPLOYERS' LIABILITY A ANY PROPRIETOR/PARTNER/EXECUTIVE~ N/A WC 5747084 02 3/30/2015 3/30/2016 E.L. EACH ACCIDENT $ 11000,000 OFFICER/MEMBER EXCLUDED? JMandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 f yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 11000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additonal Remarks Schedule, may be attached if more space is required) Re: Lease #190179 Subject to their terms and conditions, the above referenced liability policies (excluding Workers' Compensation and Employers Liability) include Ashland Parks and Recreation as Additional Insured in regards to work performed by employees, agents and subcontractors of MSC in the course of delivering, installing, repairing and/or removal of modular buildings leased or purchased from MSC. 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. Ashland Parks and Recreation AUTHORIZED REPRESENTATIVE Attn: Kari Olson 90 N. Mountain Ave. Ashland, OR 97520 Coll:4656980 Tpl:1938603 Cert:23007957 ©1988-2014ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD