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HomeMy WebLinkAboutInsurance Certificate: S&S Sheet Metal Inc AC" ® DATE (MM/DD/YYYY) 16.~ CERTIFICATE OF LIABILITY INSURANCE 04/24/2015 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 endorsements . PRODUCER CONTACT FEDERATED MUTUAL INSURANCE COMPANY NAME: CLIENT CONTACT CENTER PHONE FAX HOME OFFICE: P.O. BOX 328 A/C No Ext : 888-333-4949 A/c No : 507-446-4664 OWATONNA, MN 55060 E-MAIL ADDRESS: CLIENTCONTACTCENTER FEDINS.COM INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 343-547-6 INSURER B: S & S SHEET METAL INC INSURER C: 912 ANTELOPE RD WHITE CITY, OR 97503 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 126 REVISION NUMBER: 0 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 SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD MM/DDIYYYY MMIDDIYYYY GENERAL LIABILITY EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES DAMAGE ( E. RENTED occurrence $100,000 CLAIMS-MADE F XI MED EXP (Any one person) EXCLUDED A Y Y 9910853 04/24/2015 04/24/2016 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER, PRODUCTS - COMPIOP AGG $2,000,000 POLICY X PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 Ea accident X ANY AUTO BODILY INJURY (Per person) ALL OWNED SCHEDULED A AUTOS AUTOS N N 9910853 04/24/2015 04/24/2016 BODILY INJURY (Per accident) HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $1,000,000 A EXCESS LIAB CLAIMS-MADE N N 9910854 04/24/2015 04/24/2016 AGGREGATE $1,000,000 DED RETENTION WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N TORY LIMITS ER ANY PROPRIETOR/PARTNERIEXECUTIVE ❑ E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below E.L DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) SEE ATTACHED PAGE CERTIFICATE HOLDER CANCELLATION 343-547-6 1260 THE CITY OF ASHLAND OREGON SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 E MAIN ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ASHLAND, OR 97520-1814 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 343-547-6 LOC ACOR" ADDITIONAL REMARKS SCHEDULE Page Of AGENCY NAMED INSURED FEDERATED MUTUAL INSURANCE COMPANY S & S SHEET METAL INC POLICY NUMBER 912 ANTELOPE RD SEE CERTIFICATE # 126.0 WHITE CITY, OR 97503 CARRIER NAIC CODE SEE CERTIFICATE # 126.0 EFFECTIVE DATE: SEE CERTIFICATE # 126.0 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE CERTIFICATE HOLDER NAME IS AMENDED TO READ THE CITY OF ASHLAND, OREGON ITS ELECTED OFFICIALS, OFFICERS & EMPLOYEES. PROJECT: HVAC SYSTEM INSTALL - NO. MOUNTAIN SHOP EFFECTIVE 07/28/14 THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, LESSORS OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU ENDORSEMENT FOR GENERAL LIABILITY. INSURANCE PROVIDED BY THE GENERAL LIABILITY COVERAGE IS PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE. GENERAL LIABILITY CONTAINS A WAIVER OF SUBROGATION IN FAVOR OF THE CERTIFICATE HOLDER SUBJECT TO THE CONDITIONS OF THE BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY ENDORSEMENT. EACH CONSTRUCTION PROJECT AS REQUIRED BY WRITTEN CONTRACT OR WRITTEN AGREEMENT. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD