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HomeMy WebLinkAboutInsurance Certificate: Potelco Inc ACORD' CERTIFICATE OF LIABILITY INSURANCE F DATE(MM/DD/YYYY) 5/1/2017 4/5/2016 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). CONTACT PRODUCER LOCKTON COMPANIES N AME: 5847 SAN FELIPE, SUITE 320 HOE AX Ext: No HOUSTON TX 77057 E-MAIL 866-260-3538 ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A : Old Republic Insurance Company 24147 INSURED POTELCO, INC. INSURER B : ACE Property & Casual Insurance Co 20699 1364742 A QUANTA SERVICES COMPANY 14103 STEWART RD. INSURER c SUMNER WA 98390 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 12424201 REVISION NUMBER: XXXXXXX 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y N MWZY 307276 5/1 /2016 5/1/2017 EACH OCCURRENCE 5,000,000 A CLAIMS-MADE❑ OCCUR MWZX 307278 5/1/2016 5/1/2017 DAMAGE TO RENTED 5,000,000 X PREMISES Ea occurrence MED EXP (An one person) 10,000 PERSONAL & ADV INJURY $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 POLICY❑ PECOT- ❑ LOC PRODUCTS - COMP/OP AGG $ 5,000,000 OTHER A AUTOMOBILE LIABILITY Y N MWTB 307275 5/1/2016 5/1/2017 COMBINED SINGLE LIMIT Ea accident $ 5,000,000 X ANY AUTO BODILY INJURY (Per person) $ XXXXXXX X AUTOWNED AUTODULED BODILY INJURY (Per accident $ XXXXXXX X HIRED AUTOS X AUUTOS NED PROPERTY DAMAGE $XXXXXXX B X UMBRELLA LIAB NOCCUR N N XOC 627972032 001 5/1/2016 5/1/2017 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ S 000 000 DED RETENTION $ $ XXXXXXX WORKERS COMPENSATION PER OTH- A AN D EMPLOYERS' LIABILITY Y/ N N MWC 307277 00 5/1/2016 5/1/2017 X STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N N/A E.L. EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE 1,000,000 yes describe under D DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 L FL I I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: All Operations General Liability And Auto Liability Policies Include The City Of Ashland, Oregon, And Its Elected Officials, Officers And Employees As An Additional Insured When Required By Written Contract But Only As Respects Liability Arising Out Of Named Insured's Work For Additional Insured. 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. 12424201 AUTHORIZED REPRESENTATIVE The City Of Ashland, Oregon Attn: Kari Ann Olson 90 N. Mountain Ave. Ashland OR 97520 ccf~_ ACORD 25 (2014/01) ©1988-2014 ACORD CORPORATI . All rights reserved The ACORD name and logo are registered marks of ACORD