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HomeMy WebLinkAboutInsurance Certificate: Canyon Hydro OP ID: MH A~RL~ CERTIFICATE OF LIABILITY INSURANCE DATE /YYYY) 11 /116126/2016 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: Inland Insurance Inc. PHONE FAX 9016 E Indiana Ave., Suite A ! A/C No Ext : A/C, No : Spokane Valley, WA 99212 N A ' d i AE. DRIL John L Green PRODUCER CANYO-2 CUSTOMER ID qa . _ INSURER(S) AFFORDING COVERAGE NAIC # INSURED Canyon Industries, Inc. INSURER A : Depositors Insurance Company 42587 dba Canyon Hydro INSURER B : AIG Specialty Insurance Co 26883 PO Box 36 INSURER c : AGCS Marine Ins Co 22837 Deming, WA 98244 INSURER D : Riverport Insurance Co 36684 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: COA-15 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 GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 B X COMMERCIAL GENERAL LIABILITY X X EG 13579318-4 11/23/2016 11/23/2017 PREMISES DAMAGES ( Ea RENTED occurrence $ 300,000 7] CLAIMS-MADE a OCCUR MED EXP (Any one person) $ 25,000 X Incl Pollution PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 JECT RO- LOC $ 7 POLICY X P AUTOMOBILE LIABILITY X X COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) A X ANY AUTO ACP7564779901 11/23/2016 11/23/2017 BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (PER ACCIDENT) NON-OWNED AUTOS $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 B X X EGU 13579377-4 11/23/2016 11/23/2017 DEDUCTIBLE i $ i RETENTION $ WORKERS COMPENSATION X WC STATU OTH- AND EMPLOYERS' LIABILITY TORY LIMITS ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N AEG 13579318-4 WA STOP GAP 11/23/2016 11/23/2017 E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N/A D (Mandatory in NH) AKARP300008 AK 02/01/2016 02/01/2017 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ C Installation Fltr SML93026804 11/23/2016 11/23/2017 Location 1,000,000 Ded: $5,000 Transit 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The City of Ashland, Oregon and its elected officials, officers and employees are granted additional insured status on any insurance policies required herein-but only with respect to Contractor's services to be provided under contract for: Reeder Gulch Hydroelectric Project.Coverage is rima and non-contributory with waiver of subro ation.Should an of the CERTIFICATE HOLDER CANCELLATION CITY035 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 goz~,, L,.A~ ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD NOTEPAD. HOLDER CODE CITY035 CANYO-2 PAGE 2 INSURED'SNAME Canyon Industries, Inc. OP ID: MH Date 11/16/2016 above described policies be cancelled before expiration date thereof, 30 days notice will be provided / 10 days notice for non-payment of premium.