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HomeMy WebLinkAboutInsurance Certificate: HazmatlQ by Federal Resources 186023 ACS ~ DATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 2/16/2016 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 endorsements . CONTACT Debbie Archimbaud PRODUCER NAME: Commercial Lines - (919) 676-8834 PHONE 919-334-2605 FAX A/C No : Wells Fargo Insurance Services USA, Inc. E-MAIL ADDRESS: debbie.archimbaud@wellsfargo.com 8540 Colonnade Center Drive, Suite 111 INSURERS AFFORDING COVERAGE NAIC # Raleigh, NC 27615 INSURER A : Great Northern Insurance Company 20303 INSURED INSURER B : Granite State Insurance Company 23809 HazmatlQ by Federal Resources INSURER C : 235-G Log Canoe Circle INSURER D : INSURER E : Stevensville MD 21666 INSURER F : COVERAGES CERTIFICATE NUMBER: 10149548 REVISION NUMBER: See below 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 ADUL SUM POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE WVD POLICY NUMBER MMIDDI MMIDD/YYYY A X COMMERCIAL GENERAL LIABILITY 35894855 02/16/2016 02/16/2017 EACHOCCURRENCE $ 1,000,000 ~MA CLAIMS-MADE I-XI OCCUR PREMISES Ea occurrence $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL a ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 7 - X POLICY F7 PRO JECT ❑ LOC PRODUCTS - COMPIOP AGG $ 2,000,000 OTHER: A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1.000,000 73587445 02/16!2016 02/16/2017 Ea accident) 1 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS NAUTOS ON OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION 02/16/2016 02/16/2017 X 1 PER STATUTE X OERH USLaH B AND EMPLOYERS' LIABILITY WC13673775 YIN E L. EACH ACCIDENT $ 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under SCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 DE DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Ashland, Oregon is included as additional insured for General Liability, Automobile Liability, and Professional Liability as their interest may appear as required by written contract. Coverage is primary and non-contributory. L CERTIFICATE HOLDER CANCELLATION The City of Ashford, Oregon SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 East Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE The ACORD name and logo are registered marks of ACORD ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) 11111111111111111111 IN IIIII 111111 IIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII •CYB01A16/001269/02/0210/0/0/0•