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HomeMy WebLinkAboutInsurance Certificate: Industrial Systems (2) 1 ® DATE (MM/DDIYYYY) A~oRO CERTIFICATE OF LIABILITY INSURANCE 11/16/2015 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). CONTACT PRODUCER NAME: Employee DEFREP American Benefits Inc. PHONE (503)292-1580 FAX (503)467-4600 AIC No Ext 9755 SW Barnes Rd E-MAIL ADDRESS: Suite 290 INSURER(S) AFFORDING COVERAGE NAIC # Portland OR 97225 INSURERA:Libe - Liberty Northwest 41939 INSURED INSURER B Hartford Accident And Indemnit 22357 Industrial Systems, Inc. INSURERC:Indl - Admiral Insurance Company 5835 NE 122nd Ave Suite 110 INSURER D: INSURER E : Portland OR 97230 INSURER F: COVERAGES CERTIFICATE NUMBER:CL15111602225 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM!DD/YYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED A CLAIMS-MADE ❑X OCCUR PREMISES Ea occurrence $ 2,000,000 BZS54620179 1/1/2015 1/1/2016 MED EXP (Any one person) $ 15 , 000 PERSONAL BADVINJURY $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 4,000,000 X POLICY ❑ PRO ❑ LOC PRODUCTS - COMP/OPAGG $ 4,000,000 JECT OTHER: Employee Benefits $ COM AUTOMOBILE LIABILITY (Ea accident SINGLE LIMIT $ 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ A ALL OWNED SCHEDULED AUTOS AUTOS BAS 54620179 1/1/2015 1/1/2016 BODILY INJURY (Per accident) $ NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per accident X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 US054620179 1/1/2015 1/1/2016 $ DIED X 7ETENTION$ 10,000 WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY YIN STATUTE ER . ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A El EACH ACCIDENT $ 1,000,000 B OFFICER/MEMBER EXCLUDED? 52WECLR7227 11/1/2015 11/1/2016 E.L. DISEASE - EA EMPLOYE $ 1, 000 , 000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 C Professional Liability E0000021111101 11/12/2015 11/12/2016 $2,000,000 A Business Interruption BZS54620179 1/1/2015 1/1/2016 12 Months ALS DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder is named as an Additional Insured with respects to the liability arising from the operations of the Named Insured. 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 20 East Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE Jim Hisatomi/DEBBIE _ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD