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HomeMy WebLinkAboutInsurance Certificate: Industrial Systems Inc TE (MM/DDIYYYY) A oO " CERTIFICATE OF LIABILITY INSURANCE 71/7/2016 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 Debbie Freadman NAME: American Benefits Inc. a/~ No Ext: (503) 292-1580 No: (503)467-4600 4800 SW Griffith Drive E-MAIL Debbie@abipdx.com ADDRESS: Suite 300 INSURER(S) AFFORDING COVERAGE NAIC # Beaverton OR 97005 INSURERA:Ohio Security Insurance Company 24082 INSURED INSURERB:Ohio Casualty Insurance Co. 24074 Industrial Systems Inc INSURERC:Hartford Accident And Indemnit 22357 5835 NE 122nd Ave Ste 110 INSURER DAdmiral Insurance Company INSURER E : Portland OR 97230 INSURER F: COVERAGES CERTIFICATE NUMBER:CL161702374 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDD/YYYY MMIDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED 2,000,000 A CLAIMS-MADE 1 OCCUR PREMISES Ea occurrence $ BZS54620179 1/1/2016 1/1/2017 MED EXP (Any one person) $ 15,000 PERSONAL 8 ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 4,000,000 X POLICY PRO- LOC PRODUCTS - COMP/OP AGG $ 4,000,000 JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 A X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BAS54620179 1/1/2016 1/1/2017 BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident) I X UMBRELLA LIAB OCCUR EACH OCCURRENCE I$ 2,000,000 B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DED X RETENTION$ 10,000 US054620179 1/1/2016 1/1/2017 $ WORKERS COMPENSATION SPER OTH- AND EMPLOYERS' LIABILITY YIN TATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N / A C (Mandatory in NH) ! 52WECLR7227 11/1/2015 11/1/2016 E L DISEASE- EA EMPLOYE $ 1; 000 , 000 If yes, describe under - - DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT T$ 1,000,000 D Professional Liability E0000021111101 11/12/2015 11/12/2016 $ 2,000,000 A Business Interruption 13z554620179 1/1/2016 1/1/2017 12 Months ALS DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may tie 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/KATG ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401)