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HomeMy WebLinkAboutInsurance Certificate: Modular Space Corporation A CERTIFICATE OF LIABILITY INSURANCE Page 1 of 1 03// /30/2016) 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 l CONTACT Willis of Pennsylvania, Inc. I-PPHONE FAX c/o 26 Century Blvd. _(A/C NQL EXT1: 877-945-7378 IA/c_uo) 888-467-2378 P. O. Box 305191 E-MAIL Nashville, TN 37230-5191 certificates@willis.com INSURER(S)AFFORDING COVERAGE NAIC # INSURERA:Zurich American Insurance Company 16535-006 INSURED Modular Space Corporation INSURER B: Continental Casualty Company _ 20443-001 1200 Swedesford Road INSURERC: Berwyn, PA 19312-1078 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 24290231 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. INSRT TYPE OF INSURANCE ADDL SUB POLICY NUMBER POLICY EFF POLICY EXP LIMITS INqD COMMERCIAL GENERAL LIABILITY GLO 5747082 03 3/30/2016 '13/30/2017 EACH OCCURRENCE $ 1,000,000 ~AL _ CLAIMS-MADE! $ OCCUR ENTED PREMES~Ea occurence) - $ - 3 Q 01-- 0 0 0 M ED EXP (Any one person) $ _ 10, _00 0 PERSONAL 8 ADV INJURY $ 1,000,000 H - GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ _2L000, 000 ,X j POLICY E] JE LOC PACTS -COMP/OP AGG $ 2,000,000 OTHER: is A AUTOMOBILE LIABILITY BAP 5747081 03 3/30/2016 113/30/2017 COMBINED SINGLE LIMIT (Ea accident) $ 2,000,000 X ANYAUTO BODILY INJURY(Per person) - ALL OWNED AUTOS AUTOS BODILY $ X HIRED AUTOS X ASCHEDULED INON-OWNED PROPERTY DAMAGE -.-_I I (Per accident) $ I 1 $ B R_EN_C_E _ $ 5, 00Q 000- UMBRELLA LIAB X OCCUR L6011986371 3/30/2016 13/30/2017 EACH OCCUR X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,0 Q Q 000 DED !RETENTION $ S ii ER - A WORKERS COMPENSATION WC 5747084 03 3/30/2016 3/30/2017 X MU TE_ TH- ANDEMPLOYERS'LIABILITY A ANY PROPRIETOR/PARTNER/EXECUTIVE NN N/A WC 5747083 03 3/30/2016 13/30/2017 ELEACH ACCIDENT $ 1,000,000 1 1 I OFFICER/MEMBER EXCLUDED? I E.L. DISEASE - EA EMPLOYEE $ 1,000,000 4f yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT I$ 1,000,000 i I ~ i I DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additonal Remarks Schedule, may be attached if more space is required) Re: Lease #190179 Subject to their terms and conditions, the above referenced liability policies (excluding Workers' Compensation and Employers Liability) include Ashland Parks and Recreation as Additional Insured in regards to work performed by employees, agents and subcontractors of MSC in the course of delivering, installing, repairing and/or removal of modular buildings leased or purchased from MSC. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Ashland Parks and Recreation AUTHORIZED REPRESENTATIVE Attn: Kari Olson 90 N. Mountain Ave. Ashland, OR 97520 Coll:4875902 Tpl:2042575 Cert:24290231 ©1988-2014ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD