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HomeMy WebLinkAboutInsurance Certificate: Electric Power Systems AC" ® CERTIFICATE F LIAB DATE (MM/DD/YYYY) O ILITY INSURANCE 10/5/2016 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). PRODUCER CONTACT NAME: Brenda Nolin, CIC, CISR Alaska USA Insurance Brokers LLC A/o Nom _(907)561-1250 AX No: (907)561-4315 P.O. Box 196530 E-MAIL ADDRESS: b.nolin@alaskausainsurance.com _ INSURER(S) AFFORDING COVERAGE NAIC # Anchorage AK 99519 INSURERA:Evanston Insurance Co. INSURED INSURERB:Alaska National Ins. Company 38733 Electric Power Systems Inc. INSURER C:Navl ators Insurance Company 3305 Arctic Blvd. INSURER D: Suite 201 INSURER E : Anchorage AK 99503 INSURER F : COVERAGES CERTIFICATE NUMBER:15-16 EPS Master 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY AM Best Rating: A XV EACH OCCURRENCE $ 11000,000 A X CLAIMS-MADE [XI OCCUR Worldwide Facilities DAMAGE TO RENTED 50, 000 PREMISES Ea occurrence $ X Wa Stop Gap X 15PKGWE00294 12/1/2015 12/1/2016 MED EXP (Any one person) $ 51000 X Surplus Lines Policy *Contrators Pollution $lMM PERSONAL & ADV INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: CPL Ded: $25,000 *Shared Agg GENERAL AGGREGATE $ *2, 000, 000 X POLICY JPE LOC *Professional Liab $1MM PRODUCTS COMP/OP AGG $ 2,000,000 X OTHER: CPL & PL Claims Made* Prof Liab Ded: $25,000 Deductible $ 10,000 AUTOMOBILE LIABILITY AM Best Rating: A IX COMBINED SINGLE LIMIT $ 1,000,000 Ea accident B X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED X 15LAS59601 12/1/2015 12/1/2016 BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per accident' Medical payments $ 51000 UMBRELLA LIAB X OCCUR XS-GL/Auto/Emp Liab/Poll/ AM Best: A XI EACH OCCURRENCE $ 10,000,000 C X EXCESS LIAB CLAIMS-MADE Prof. *Surplus Lines Pol AGGREGATE $ 10, 000, 000 DED RETENTION $ LA15EXC7199081C 12/1/2015 12/1/2016 Product Comp/Ops Aggregate $ 10, 000, 000 WORKERS COMPENSATION AM Best Rating: A IX X PER OTH- STATUTE ER AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 11000,000 - - - OFFICER/MEMBER EXCLUDED? N N/A B (Mandatory in NH) 15LWS59601 12/1/2015 12/1/2016 E.L. DISEASE - EA EMPLOYE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below USL&H Included E.L. DISEASE -POLICY LIMIT $ 1,000,000 A Environmental Following 15EFXWE1000404 12/1/2015 12/1/2016 General Liab: $1,000,000 Prof: $1MM Form. Excess GL, CPL & PL Surplus Lines Policy Pollution Liab: $1,000,000 Gen Agg: $1MM DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: RFP - Engineering Services The Certificate Holder is an Additional insured on the General Liability & Automobile policies, but only with respect to work done by or on behalf of the named insured for the project referenced. Subject to policy terms, conditions & exclusions. It is agreed that such insurance as afforded the Certificate Holder on the General Liability & Automobile policies shall be primary and non-contributory with any other insurance in force for or which may be purchased by the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland, Oregon THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN and its elected officials, officers ACCORDANCE WITH THE POLICY PROVISIONS. & employees 20 East Main Street AUTHORIZED REPRESENTATIVE Ashland, OR 97520 B Nolin, CIC, CISR/BR © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401) COMMENTS/REMARKS CANCELLATION AS PER ALASKA STATUTE AS 21.36.220 At least 10 days' notice of cancellation is required if cancellation is for conviction of the insured of a crime having as one of its necessary elements an act increasing a hazard insured against, or for discovery of fraud or material misrepresentation made by the insured or a representative of the insured in obtaining the insurance or by the insured in pursuing a claim under the policy. At least 20 days' notice is required for nonpayment of premium or for failure or refusal of the insured to provide the information necessary to confirm exposure or necessary to determine the policy premium. At least 60 days' notice is required if cancellation is for any reason except as previously noted. Advance Notice Required for Nonrenewal Except in case of nonpayment of premium for the expiring policy, or if the insured fails to pay the premium as required by the insurer for renewal, an insurer may not fail to renew a policy unless a written notice of nonrenewal is mailed at least 45 days before the expiration date of the policy or of the anniversary date of a policy written for a term longer than 1 year or with no fixed expiration date. If notice of nonrenewal is not given as required, the existing policy shall continue until the insurer provides notice for the time period required by this section for that policy. This section does not apply if the insurer has in good faith manifested its willingness to renew. [AS 21.36.2401 Advance Notice Required for Premium or Coverage Changes Written notice shall be mailed to the insured and to the agent or broker of record at least 45 days before expiration: *if renewal premium is increased more than 10 percent for a reason other than an increase in coverage or exposure base, or *if after renewal there will be a material restriction or reduction in coverage not specifically requested by the insured. If notice before expiration of the policy is not given as required by this section, the existing policy shall continue until the insurer provides notice for the time period required for that policy. This section does not apply to workers compensation insurance. OFREMARK COPYRIGHT 2000, AMS SERVICES INC. COMMENTS/REMARKS ALASKA SURPLUS LINES WORDING: "This is evidence of insurance procured and developed under the Alaska Surplus Lines Law AS21.34. It is not covered by the Alaska Insurance Guarantee Association Act, AS21.80. This insurer does not hold a certificate of authority with Alaska, and is not subject to supervision by the Alaska Department of Insurance" Worldwide Facilities, Inc. - License #9718 OFREMARK COPYRIGHT 2000, AMS SERVICES INC.