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HomeMy WebLinkAboutInsurance Certificate: Universal Field Services UNIVt-1 UP ID: DE CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 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 NCONTACT AME: Terry D. Cupp, CIC THE ARROW GROUP PHONE FAX 918-251-7893 2720 N. Hemlock Ct Ste A A/C No Ext : 918-258-6681 p/C JO L 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 PO Box 35666 INSURER C Tulsa, OK 74153 INSURER D : INSURER E INSURER F: I 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE IN D WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 TO - CLAIMS-MADE FXIOCCUR X P-630-6A369504 09/30/2016 09/30/2017 PREMISES DAMAGES ( Ea RENTED occurrence $ 100,000 MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY ❑ PROJECT ❑ LOC PRODUCTS COMP/OP AGG $ 3,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident 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 HIREDAUTOS NON- PROPERTY DAMAGE $ AUTOS OWNED Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE CUP-6A369504 09/30/2016 0913012017 AGGREGATE $ 5,000,000 DED X RETENTION $ 0 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y / N STATUTE ER E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ B Professional DPL10004211403 09/30/2016 09/30/2017 Per CLM 5,000,000 aggregate 5,000,000 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 (2014/01) The ACORD name and logo are registered marks of ACORD