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HomeMy WebLinkAboutInsurance Certificate: RH2 Engineering TE (MM/DD/YYYY) r ® 78/6/2015 CERTIFICATE OF LIABILITY INSURANCE 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 Allen Fugitt CPCU NAME: Sammamish Insurance, Inc. PHONE (425) 898-8780 FAX (425)836-2865 A/C, o_Ext):-- (A/C Noh---- 704 228th Ave NE, PMB 373 E-MAIL Allen_Fugitt@msn.com ADDRESS: _ INSURER(S) AFFORDING COVERAGE NAIC # Sammamish WA 98074 INSURER A:Hartford Casualty Ins. Co. 29424 INSURED INSURER B :Sentinel Insurance Co. , Ltd 11000 RH2 ENGINEERING INC INSURER C_:Con_tinental Casu_altVCompany h20443 22722 29TH DR SE STE 210 WsURERD: INSURER E BOTHELL WA 98021 INSURER F COVERAGES CERTIFICATE NUMBER:CL157902632 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. 71JSR ADDL SUBR - - - POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITYEACH OCCURRENCE $ 2,000,000 - - - --t- - - DAMAGE TORENTED - 300,000 OCCUR OCCUR A CLAIMS-MADE X X 52 SBANM5475 PREMISES (Ea occurrence) ! $ 8/16/2015 8/16/2016 MED EXP (Any one person) 10 , 000 PERSONAL 8 ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 0 GG $ JECT LOC Employee Benefits r $ 24,,000000,,000 OTHER : r PRO- 00 X POLICY I i, COMB/NET D SINGLE OM/O LIMIT AUTOMOBILE LIABILITY SCHEDULED (Ea accidence- $ 1,000,000 ANY ALL AUTO OWNED BODILY INJURY (Per person) - - - - B - 52UECHY3821 8/16/2015 8/16/2016 BODILY INJURY Per accident) $ i AUTOS X f AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per accidentL__ Medical payments $ 10,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2 , 000 , 000 A I. EXCESS LIAB _ _CLAIMS-MADE AGGREGATE $ 2,000,000 DIED J FIETENTION$ 10,000 !52SBANM5475 8/16/2015 8/16/2016 k%xNMxafDtAE}G~Kxww PER ~ X OTH- 1 000,000 xIQ(EMPLOYERS' LIABILITY Y / N STATUTE ER . ANY PROPRIETOR/PARTNER/EXECUTIVE N/A A OFFICER/MEMBER EXCLUDED? N E L EACH ACCIDENT $ 52SBANM5475 8/16/2015 8/16/2016 (Mandatory in NH) EL . DISEASE EA EMPLOYEE 1,000,000 Ilfvec de.-ripe under DESCRIPTION OF OPERATIONS below E. L_UISEASt - PULIi:f Liro71 1 1 Ju0 1300 C Professional Liability AEHOO4312321 5/29/2015 5/29/2016 Per Claim $3,000,000 Claims Made Deductible $200,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Ashland is named as additional insured. CERTIFICATE HOLDER CANCELLATION i SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 520 N Main St ACCORDANCE WITH THE POLICY PROVISIONS. . Ashland, OR 97520 AUTHORIZED REPRESENTATIVE A Fugitt CPCU/JONA © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401)