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HomeMy WebLinkAboutInsurance Certificate: C&S Fire-Safe Services DATE (MM/DD/YYYY) ACC W?" CERTIFICATE OF LIABILITY INSURANCE 11/3/2016 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 Deborah Ra NAME: y Trinity Insurance Agency, Inc. Via//C, No, Ext): (541) 942-8870 (A/c, No): (541) 942-8870 E-ML DDRESS: dray@trinityinsurance.us PO Box 565 A INSURER(S) AFFORDING COVERAGE NAIC # Cottage Grove OR 97424 INSURERA:Tokio Marine Specialty Ins. Co. 23850 INSURED INSURER B :Philadelphia Indemnity Insurance Co 18058 C & S Fire-Safe Services, LLC INSURER C : 4019 Hooker RD INSURER D : INSURER E : Roseburg OR 97470-1170 INSURER F : COVERAGES CERTIFICATE NUMBER:CL1611200151 i 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. POLICY EFF POLICY EXP INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MM/DD/YYYY MM LTR / D/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100 , 000 A CLAIMS-MADE X OCCUR PREMISES (Ea occurrence) $ X PPK1573207 10/30/2016 10/30/2017 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X PRO- LOC PRODUCTS - COMP/OP AGG $ 2,000,000 JECT OTHER: Professional Liability $ Included AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) B ANY AUTO BODILY INJURY (Per person) $ ALL OWNED X SCHEDULED AUTOS X PHPK1572178 10/30/2016 10/30/2017 BODILY INJURY (Per accident) $ X X NON-OWNED O TY DAMAGE $ HIRED AUTOS AUTOS (Per accident) UM/UIM $ 1,000,000 UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 A X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DED X RETENTION$ 0 PUB562491 10/30/2016 10/30/2017 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y! N STATUTE ER ANY PROPRIETOR/PARTNER/EXECU-i IVE E.L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E I DISEASE - EA EMPLOYEE $ If yes describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Environmental Liablity PHPK1573212 10/30/2016 10/30/2017 Each Occurrence $1,000,000 B Employee Theft & Client Cvg PHSD1192414 10/30/2016 10/30/2017 Limit $50,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Contractor: Fire Suppression Systems, Fire Extinguishers, Alarm Systems and Sprinkler Systems - Installation, Servicing or Repair. The certificate holder is an additional insured per the attached CG 2012 0413 endorsement. Blanket Additional insured included for Auto on the attached PI CA 003 0414 endorsement. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn : Dale Peters ACCORDANCE WITH THE POLICY PROVISIONS. 20 E Main St Ashland, OR 97'5520 AUTHORIZED REPRESENTATIVE Deborah Ray/DRAY © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401) POLICY NUMBER: F P K 1-'7 3 2 0 7 COMMERCIAL GENERAL LIABILITY CG 20120413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: AS REQUIRED BY WRITTEU rnN` P,PCl EYIE =r?TL.f' J TO ,-rl OCCURRENCE OR OFFENSE. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to 2. This insurance does not apply to, include as an additional insured any state or a. "Bodily injury", "property damage" or governmental agency or subdivision or political "personal and advertising injury" arising out subdivision shown in the Schedule, subject to the of operations performed for the federal following provisions: government, state or municipality; or 1. This insurance applies only with respect to b. "Bodily injury" or "property damage" operations performed by you or on your behalf included within the "products-completed for which the state or governmenfaf agency or operatbns hazard". subdivision or political subdivision has issued B. With respect to the insurance afforded to these a permit or authorization. additional insureds, the following is added to However: Section III - Limits Of Insurance: If coverage provided to the additional insured is a. The insurance afforded to such additional required by a contract or agreement, the most we insured only applies to the extent permitted will pay on behalf of the additional insured is the by law; and amount of insurance: b. If coverage provided to the additional 1. Required by the contract or agreement; or insured is required by a contract or 2. Available under the applicable Limits of agreement, the insurance afforded to such Insurance shown in the Declarations; additional insured will not be broader than whichever is less. that which you are required by the contract or agreement to provide for such additional This endorsement shall not increase the insured. applicable Limits of Insurance shown in the Declarations. CG 2012 0413 V Insurance Services Office, Inc., 2012 Page 1 of 1 PI-CA-003 (04/14) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A. SECTION If - COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 1. Who Is An Insured is amended by adding the following: The following are also "insureds": Any person or organization for whom you are required by an "insured contract" to procure "bodily injury" or "property damage" liability insurance arising out of the operation of a covered "auto" with your permission. However, this additional insurance does not apply to: 1. The owner or anyone else from whom you hire or borrow a covered "auto." This exception does not apply if the covered "auto" is a "trailer" connected to a covered "auto" you own; 2. Your "employee" if the covered "auto" is owned by that "employee" or a member of his or her household; 3. Anyone using a covered "auto" while he or she is working in a business of selling, servicing, repairing, parking or storing "autos" unless that business is yours; 4. Anyone other than your "employees," partners (if you are a partnership), members (if you are a limited liability company), or a lessee or borrower or any of their "employees," while moving property to or from a covered "auto"; or 5. A partner (if you are a partnership), or a member (if you are a limited liability company) for covered "auto" owned by him or her or a member of his or her household. B. The "insured contract" must be in effect during the policy period shown in the Declarations and must have been executed prior to the "bodily injury" or "property damage". C. This person or organization is an "insured" only to the extent you are liable due to your ongoing operations for that "insured", whether the work is performed by you or for you, and only to the extent you are held liable for an "accident" occurring while a covered "auto" is being driven by you or one of your employees. D. There is no coverage provided to this person or organization for "bodily injury" to its employees or for "property damage" to its property. E. Coverage for this person or organization shall be limited to the extent of your negligence or fault according to the applicable principles of comparative negligence or fault. F. The defense of any claim or "suit" must be tendered by this person or organization as soon as practicable to all other insurers which potentially provide insurance for such claim or "suit". G. A person's or organization's status as an "insured" under this endorsement ends when your operations for that "insured" are completed. Page 1 of 2 PI-CA-003 (04/14) H. The coverage extended to any additional insured by this endorsement is limited to, and subject to all terms, conditions, and exclusions of the Coverage Part to which this endorsement is attached. In addition, coverage shall not exceed the terms and conditions that are required by the terms of the written agreement to add any "insured," or to procure insurance. 1. The following additional exclusions apply: The insurance afforded to any person or organization as an "insured" under this endorsement does not apply to "loss": 1. Which occurs prior to the date your contract is effective with such person or organization; 2. Arising out of the sole negligence of any person or organization that would not be an "insured" except for this endorsement; or 3. Which occurs after you returned the leased or rented "auto" to the lessor or the policy period ends, whichever occurs first. Page 2 of 2