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HomeMy WebLinkAboutInsurance Certificate: Potelco Inc AC"RCERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 5/1/2016 3/31/2015 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 LOCKTON COMPANIES NAME: ACT 5847 SAN FELIPE, SUITE 320 A/C, No, Ext ; IFAX A/C, No : HOUSTON TX 77057 E-MAIL 866-260-3538 ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A : Old Republic Insurance Com att24147 INSURED POTELCO, INC. INSURER B : ACE Property & Casual Insurance Co 20699 1364742 A QUANTA SERVICES COMPANY INSURER C : 14103 STEWART RD. SUMNER WA 98390 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 12424201 REVISION NUMBER: XXXXXXX 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. ILTR ADDL SUBR POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MMIDD/YYYY A X COMMERCIAL GENERAL LIABILITY Y N MWZY 304377 5/1/2015 5/1/2016 EACH OCCURRENCE 5,000,000 A CLAIMS-MADE OCCUR MWZX 304375 5/1/2015 5/1/2016 DAMAGE TO RENTED 5,000,000 PREMISES Ea occurrence MED EXP (An one person) 10,000 PERSONAL & ADV INJURY $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 POLICY 7 PRO ❑ LOC PRODUCTS - COMP/OP AGG $ 5,000,000 JECT OTHER $ A AUTOMOBILE LIABILITY Y N MWTB 304394 5/1/2015 5/1/2016 Ea aBIEDtSINGLE LIMIT $ 5,000,000 Ix ANY AUTO BODILY INJURY (Per person) $ X'X'XXXX ALL OWNED SCHEDULED BODILY INJURY (Per accident $ XXXXXXX AUTOS AUTOS HIRED AUTOS X AUTO WNED Perr accidentDAMAGE $ XXXXXXX $ XXXXXXX B X UMBRELLA LIAB X OCCUR N N XOOG27320569 5/1/2015 5/1/2016 EACH OCCURRENCE $ 51000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 51000,000 DED RETENTION $ $ XXXXXXX A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N N MWC 304378 00 5/1/2015 5/1/2016 X STATUTE oTH- ANY PROPRIETOR/PARTNER/EXECUTIVE N / A E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: All Operations General Liability And Auto Liability Policies Include The City Of Ashland, Oregon, And Its Elected Officials, Officers And Employees As An Additional Insured When Required By Written Contract But Only As Respects Liability Arising Out Of Named Insured's Work For Additional Insured. 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. 12424201 AUTHORIZED REPRESENTATIVE The City Of Ashland, Oregon Attn: Kari Ann Olson 90 N. Mountain Ave. Ashland OR 97520 ACORD 25 (2014/01) ©1988-2014 ACORD CORPORATI . All rights reserved The ACORD name and logo are registered marks of ACORD