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HomeMy WebLinkAboutInsurance Certificate: Osmose Utilities Services ~ 1 ® DATE (MM/DDIYYYY) ° CERTIFICATE OF LIABILITY INSURANCE 6/20/2016 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 NAME: Christie Geiger A/C No): (716) First Niagara Risk Management, Inc P(Al . No. HONE , (716) 819-5500 FAX E-ML 726 Exchange Street Suite 900 ADDRESS: Christie.Geiger@fnrm.com INSURERS AFFORDING COVERAGE NAIC # Buffalo NY 14210 INSURER.A:Zurich American Insurance 16535 INSURED INSURER B :Llo d Is of London 15792 Osmose Utilities Services Inc INSURERC:QBE Insurance Corporation 39210 635 Highway 74 INSURERD:Travelers Property Casualty Co 25674 INSURERS National Fire & Marine Company 20079 Peachtree City GA 30269 INSURER F : COVERAGES CERTIFICATE NUMBER:16 -17 OUS REVISION NUMBER: THIS IS TO CERTIFY THAT THE PCLICIES 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/DDIYYYY _MD GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 Ea occurrence $ 11000, 000 X COMMERCIAL GENERAL LIABILITY DAMAGE PREMISES T RENTED A CLAIMS-MADE a OCCUR X X LO 0381439 01 7/1/2016 7/1/2017 MED EXP (Any one person) $ 10,000 X Contractual Liability PERSONAL &ADV INJURY $ 11000,000 X XCU included GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 JECT RO- F X LOC $ 7 POLICY X P AUTOMOBILE LIABILITY EO aBIEDtSINGLE LIMIT 2,000,000 X ANY AUTO BODILY INJURY (Per person) $ A ALL OWNED SCHEDULED X X AP 0381440 01 /1/2016 /1/2017 BODILY INJURY (Per accident) $ AUTOS AUTOS F X X NON-OWNED 42XSF30266601 7/1/2016 /1/2017 PeOra RTY DAMAGE $ HIRED AUTOS AUTOS A X UMBRELLA LIAB X OCCUR X X E 44196661 7/1/2016 7/1/2017 EACH OCCURRENCE $ 50, 000, 000 C EXCESS LIAB CLAIMS -MADE AGGREGATE $ 50, 000, 000 DED X RETENTION$ 10,00 CU3977239 7/1/2016 7/1/2017 $ A WORKERS COMPENSATION X C 03821438 01 7/1/2016 7/1/2017 X WCSTATU- OTH TORY LIMITS I ER AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A 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 7 LS Professional Liability U5MU0116/F0SMVU216 /1;2;1G 7/11/3017 Pe, aami/a99 3,000, 000 D Lease Rented Equipment -630-6E274546-TIL-16 7/1/2016 7/1/2017 Pet Item 250,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The City of Ashland, Oregon, and its elected officials, officers and employees are Additional Insured on a primary and non-contributory basis in regard to the above Liability policies when required by executed written contract. A Waiver of Subrogation is included when required by executed written contract. Workers Compensation coverage is extended to the state of Oregon. 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. City of Ashland 90 N. Mountain Avenue Ashland, OR 97520 AUTHORIZED REPRESENTATIVE M Bonetto/CGEIGE - ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. INSO25 r,)mnns~ n, Thin A!`nPn nnn,%n and Innn nrn rnnia4nrnrl marts of &r_nan