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HomeMy WebLinkAboutInsurance Certificate: Universal Field Services UNIVE-1 UF ID: DE = CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 4 09/21/2016 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 NAME: Terry D. Cupp, CIC CONTACT THE ARROW GROUP PHONE 918-258-6681 FAX No): 918-251-7893 2720 N. Hemlock Ct Ste A A/c No Ext : Broken Arrow, OK 74012-1111 A DRIESS: Terry D. Cupp, CIC INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Travelers Property Casualty 25674 INSURED Universal Field Services, Inc. INSURER B : Endurance American Specialty 41718 Universal Real Estate, LLC INSURER C : Universal Real Estate, LLC PO Box 35666 INSURER D : Tulsa, OK 74153 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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. INSR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM DD1YYYY MM DD/YYYY LIMITS LTR D WVD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR X P-630-6A369504 09/30/2016 09/30/2017 DAMAGE TO RENTED 100,000 PREMISES Ea occurrence $ MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,00 X POLICY X I JERCOT LOC PRODUCTS - COMP/OP AGG $ 3,000,00 OTHER: AUTOMOBILE LIABILITY Ee acccidentSINGLE LIMIT $ 1,000,000 A X ANY AUTO X BA-6A369504 09/30/2016 09/30/2017 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ Per accident HIRED AUTOS AUTOS X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE CUP-6A369504 09/30/2016 09130/2017 AGGREGATE $ 5,000,000 DED X RETENTION $ 0 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ B Professional DPL10004211403 09/3012016 09130/2016 Per Clm 5,000,000 Aggregate 5,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Reference:Right of Way (R/W) Independent Way. Blanket Addl Ins Written Contracts CGL CGD4140408, Addl Ins Prim & Non Cont CGL CGD0370405, Auto Blanket Addl Ins -WOS when Written Contracts CAF1350310, Blnkt addl ins Prim Non Cont auto CAT4740215,30 Day notice of cancellation applies. Umbrella Follows form. CERTIFICATE HOLDER CANCELLATION CITYAS1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main Street Ashland, OR 97520 AUTHORIZED REPRESENTATIVE © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD