Loading...
HomeMy WebLinkAboutInsurance Certificate: Olsson Industrial Electric 7 ® DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 09/30/2015 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: Marsh USA Inc. - FAX PHONE 1301 5th Avenue, Suite 1900 AIC No. Ext): (A/c Not Seattle, WA 98101 E-MAIL Attn: Seatfle.CertRequest@marsh.com / F: 212-948-4326 ADDRESS: INSURER(S) AFFORDING COVERAGE _ NAIC # 21340 -NAES-GAWX-15-16 _ INSURER A : Zurich American Insurance Company 16535 INSURED INSURER B : American Zurich Insurance Co. 40142 Olsson Industrial Electric Inc 1180 NW Maple Street, Suite 200 INSURER C : ACE Property And Casualty Ins Co 20699 Issaquah, WA 98027 INSURER D : INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER: 13EA-003009474-01 REVISION NUMBER:2 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY GL05574116-02 05/20/2015 05/20/2016 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES Ea occurrence) $ - 1,000,000 X SIR $200,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 rGEINT AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE _ $ 2,000,000 POLICY PRO ❑ LOC PRODUCTS - COMP/OP AGG $ _ 2,000,000 JECT OTHER. A AUTOMOBILE LIABILITY BAP9830191-05 05/2012015 05/20/2016 COMBINED SINGLE LIMIT $ 1,000 000 Ea accident X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED - SCHEDULED BODILY INJURY (Per accident) $ AUTOS _ AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS _ AUTOS Per accident _ _ COMP/COLL DIED $ 1,000 C UMBRELLA LIAR OCCUR X00 G27833238 05/20/2015 05/20/2016 EACH OCCURRENCE $ 1,000,000 - rX EXCESS LIAB J_X_CLAIMS-MADE AGGREGATE $ DED X RETENTION$1,000,000 $ OTH- B WORKERS COMPENSATION WC5574117-02 (AOS) 05120/2015 05/20//2016 X PER STATUTE ER AND EMPLOYERS' LIABILITY B ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N WC5574118-02 (WI) 05/20/2015 05/20/2016 E.L. EACH ACCIDENT _ $ 1,000,000 OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Ashland, Oregon and its elected officials, officers and employees are included as Additional Insured where required by written contract and allowed by law with respect to General Liability, Automobile Liability, and Umbrella Liability. This insurance shall be primary and non-contributory and limited to liability arising out of the operations of the named insured when required by written contract CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 East Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Ashland, OR 97520 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Beverly A.Wold ,t..ly llLi~~~ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD