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HomeMy WebLinkAboutInsurance Certificate: SME Solutions LLC (2) n:Delinda Watts To:15/16 Renewal Certs. Issued on behalf of SME So (15414885320) 09:33 06/16/15 GMT-07 P9 2-3 SMESOLU-CL DWATTS A~ oRO CERTIFICATE OF LIABILITY INSURANCE DATE (MMlDDIYYYY) 611612015 THIS CERTI 'ICATE 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: George Petersen Insurance Agency, Inc. PHONE FAX P.O. Box 3539 Alc No Ext : (707) 525 4150 (A/C No : (707) 525-4175 Santa Rosa, CA 95402 ADD IIESS: info@gpins.com INSURER(S) AFFORDING COVERAGE NAIC It INSURER A Homeland Insurance Company of New York INSURED INSURER B Nationwide Mutual Insurance Company 23787 SME Solutions, LLC INSURER C 10107 S Tacoma Way, Suite A-2 INSURER D : Lakewood, WA 98499 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. INSR ADDLSUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DDIYYYY (MMIDDIYYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 7,000,000 CLAIMS-MADE I-XI OCCUR X 793-00-22-82-0001 0611412015 06/14/2016 .REMISES Ea occurrence $ 50,000 X Pollution & Professi MED EXP (Any one perscn) $ 5,000 PERSONAL & ADV INJURY $ 7,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 7,000,000 POLICY 1 JECT D LOC PRODUCTS - COMP/OPAGG $ 7,000,000 OTHER: CONTRACTORS POL $ 7,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident B X ANY AUTO ACP BA 3007045605 03(1512015 03115/2016 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS X X NON-OWNED Per0accidenfDAMAGE $ HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ It yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Labor and Materials - City's Petro Vend card reader system City of Ashland is named as Additional Insured with respects to General Liability perform OBENV GE 301 (0211) , attached. CERTIFICATE HOLDER CANCELLATION 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 N. Mountain Ave. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE ' V?_ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD n:Delinda Watts To:15/16 Renewal Certs. Issued on behalf of SHE So (15414885320) 09:33 06/16/15 GHT-07 Pg 3-3 Policy Number: 793-00-22-82-0001 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION - FORM I This endorsement only modifies coverage provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS ENVIRONMENTAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any person or organization for which the Named Insured has agreed to provide insurance prior to loss as provided by this policy but only to the scope of insurance agreed to by the Named Insured. (if no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. SECTION II - WHO IS AN INSURED is amended to include as an insured the person or organization shown in the SCHEDULE above, but only with respect to liability arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insureds, the following exclusion is added: 2. Exclusions This insurance does not apply to bodily injury, property damage or environmental damage occurring after: (a) All work, including materials, parts or equipment furnished In connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed; or (b) That portion of your work out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. All other terms and conditions remain the same. OBENV GE 301 (02 11) Includes copyrighted material of Insurance Services OtHce, Inc. 1 of 1 Copyrlght2011,One8eacon Insurance Group E-INSURED inda Watts To:15/16 Renewal Certs. Issued on behalf of SME So (15414885320) 09:33 06/16/15 GMT-07 P9 1-3 Enclosed please find the Certificate issued per your request. A copy was sent to the Holder. Should you have any question; please contact our office. Sincerely, Delinda Watts Certificate Manager Ph: 707-360-4156 Fax:707-546-4518 dwatts@gpins.com www.gpins.com George Petersen Insurance Agency and Its Affiliates Note: The information in this E-Mail message is confidential. It is intended solely for the use of the individual(s) named -above. If, ,vou are the intended recipient, be aware that your use of any confidential, proprietary and/or personal information may be restricted by state and federal privacy laws. If you are not the intended recipient, you should not distribute or forward this E-mail message. If you have received this E-mail in error, please immediately notify the sender and delete the material from any computer and/or server.