HomeMy WebLinkAboutInsurance Certificate: Olsson Industrial Electric
® DATE (MM/DD/YYYY)
ACORD CERTIFICATE OF LIABILITY INSURANCE 06/21/2016
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
Marsh USA Inc. NAME:
PHONE FAX
1301 5th Avenue, Suite 1900 A/C. No Xt : A/c No):
Seattle, WA 98101 E-MAIL
Attn: Seattle.CertRequest@marsh.com / F: 212-948-4326 ADDRESS:
INSURERS AFFORDING COVERAGE NAIC #
21340 -NAES-GAWX-16-17 INSURER A : Zurich American Insurance Company 16535
INSURED INSURER B : American Zurich Insurance Co. 40142
Olsson Industrial Electric Inc.
1180 NW Maple Street, Suite 200 INSURER C : ACE Property And Casualty Ins Co 20699
Issaquah, WA 98027 INSURER D :
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: SEA-003009474-09 REVISION NUMBER:2
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 LIMITS
LTR TYPE OF INSURANCE POLICY NUMBER MM/DDNYYY MM/DD/YYYY
A X COMMERCIAL GENERAL LIABILITY GL05574116-03 05/20/2016 05/20/2017 EACH OCCURRENCE $ 1,000,000
F-V --I DAMAGE TO CLAIMS-MADE OCCUR PREMISES (Ea occurrence) l$ 1,000,000
MED EXP (Any one person) $ 10,000
X SIR $200,000
PERSONAL & ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
X POLICY 1-1 PRO JECT F-] LOC PRODUCTS - COMP/OP AGG $ 2,000,000
OTHER. $
A AUTOMOBILE LIABILITY BAP9830191-06 05/2012016 05/20/2017 COMBINED SINGLE LIMIT
Ea accident $ 1,000,000
X ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS AUTOS
HIRED AUTOS NON- PROPERTY DAMAGE $
AUTOS OWNED Per accident
COMP/COLL DED $ 1,000
C UMBRELLA LIAB OCCUR XOC G27833138002 05/20/2016 05/20/2017 EACH OCCURRENCE $ 1,000,000
X EXCESS LIAB X CLAIMS-MADE AGGREGATE $
DED X RETENTION $1,000,000 $
B WORKERS COMPENSATION WC5574117-03 (AOS) 05/20/2016 05/20/2017 X PER OTH
B -
AND EMPLOYERS' LIABILITY STATUTE ER
Y / N WC5574118 03 (WI) I) 05/2012016 05120/2017 1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE N N/A E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) E.L DISEASE - EA EMPLOYEE $ 1,000,000
If yes, describe under 1,000,000
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
The City of Ashland, Oregon and its elected officials, officers and employees are included as Additional Insured where required by written contract and allowed by law with
respect to General Liability, Automobile Liability, and Umbrella Liability. This insurance shall be primary and non-contributory and limited to liability arising out of the operations
of the named insured when required by written contract.
CERTIFICATE HOLDER CANCELLATION
City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
20 East Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Ashland, OR 97520 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Beverly A. Wold
@ 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD