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HomeMy WebLinkAboutInsurance Certificate: Engineered Monitoring Solutions ® DATE (MM/DDNYYY) .a~o,2o CERTIFICATE OF LIABILITY INSURANCE 12/5/2016 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(les) 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. Dee Hughes _ Slater & Associates Insurance, Inc PHONE (503) 624-0466 FAX (503) 624-0846 r t(r~, Ext): A/C No : PO Box 1469 E-MAIL dee@slaterinsurance.com ADDRESS: Tualatin, OR 97062-1469 INSURERS AFFORDING COVERAGE NAIC>s INSURER A :Cincinnati Ins Co 110677 INSURED INSURER B :SAIF Corp 36196 Engineered Monitoring Solutions LLC INSURER C : 617 N Main St INSURER D : Newberg, OR 97132 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. IN SR ?DbL B POLICY EFF POLICY EXP LIMITS ~W LTR TYPE OF INSURANCE POLICY NUMBER M / M COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES (Ea occurrence S MED EXP (Any one person) $ PERSONAL & ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO POLICY ~JECT 0 LOC PRODUCTS - COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident A ANYAUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS ESA0414886 12/3/2016 12/3/2017 BODILY INJURY (Per accident) $ NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS 'Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE - $ EXCESS L1AB CLAIMS-MADE AGGREGATE $ DED RETENTION $ I I $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY TA TE ER ANY PROPRIETORIPARTNER/EXECUTIVE a E.L. EACH ACCIDENT $ 1 OFFICER/MEMBER EXCLUDED? N/A y0001000 B (Mandatory In NH) 958900 12/1/2016 12/1/2017 E.L. DISEASE - EA EMPLOYE $ 1,000,000 (Mandatory In If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION (541) 488-5320 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF ASHLAND THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn : Rob Morris ACCORDANCE WITH THE POLICY PROVISIONS. 20 E Main St Ashland, OR 97520 AUTHORIZED REPRESENTATIVE Dee Hughes / DMH-~G ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401) (MMIDDfYYYY) CERTIFICATE OF LIABILITY INSURANCE l ® 711/29/2016 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((es) 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 NACONTACT ME: FAX Mid Valley General Agency LLC PHONE AIC No E A1C. No 4305 River Road N. ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC a Keizer OR 97303 INSURER A : Scottsdale Insurance Company 41297 INSURED INSURER B : Engineered Monitoring Solutions LLC INSURER C : 617 N Main St INSURER D ; INSURER E : Newberg OR 97132 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN I S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _LTR TYPE OF INSURANCE POLICY NUMBER MMIDDNYYY MWDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 RENTED CLAIMS-MADE X OCCUR PREMISES $ 100,000 MED EXP An one person) $ 5,000 A Y CPS2602627 12103/2016 12/03/2017 PERSONAL BADVINJURY $ 1,000,000 GENt AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s 2,000,000 x POLICY 0 JECT LOC PRODUCTS - COMP/OP AGG S 2,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY (Per person) ALL OWNED SCHEDULED BODILY INJURY (Per accident) S AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS 3 UMBRELLA LIAB HOCCUR EACH OCCURRENCE S EXCESS UAB CLAIMS-MADE AGGREGATE 5 _F I DED RETENTION $ $ WORKERS COMPENSATION PER STATUTE OTN- AND EMPLOYERS' LIABILITY Y I N E.L. EACH ACCIDENT S ANY PROPRIETOR/PARTNER/EXECUTIVE NIA OFFICERIMEMBER EXCLUDED? N (Mandatory In NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is required) City of Ashland is included as additional insured per GLS-150s(07/06). CERTIFICATE HOLDER CANCELLATION 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 E Main St AUTHORIZED REPRESENTATIVE Ashland OR 97520 Otis ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD ENDORSEMENT NO. ATTACHED TO AND ENDORSEMENT EFFECTIVE DATE FORMING A PART OF (12:01 A.M. STANDARD TIME) NAMED INSURED AGENT NO. POLICY NUMBER CPS2602627 12/03/2016 ENGINEERED MONITORING SOLUTIONS LLC 36005 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART With respect to this endorsement, SECTION 11-WHO IS a. All work, including materials, parts or equip- AN INSURED is amended to include as an additional in- ment furnished in connection with such work, sured any person or organization whom you are required to on the project (other than service, mainten- add as an additional insured on this policy under a written ance or repairs) to be performed by or on be- contract, written agreement or written permit which must be: half of the additional insured(s) at the location a. Currently in effect or becoming effective during of the covered operations has been com- the term of the policy; and pleted; or b. Executed prior to the "bodily injury," "property b. That portion of "your work" out of which the in- damage," or "personal and advertising injury." jury or damage arises has been put to its in- tended use by any person or organization The insurance provided to these additional insureds is li- other than another contractor or subcontrac- mited as follows: for engaged in performing operations for a 1. That person or organization is an additional insured principal as a part of the same project. only with respect to liability for "bodily injury," 3. The limits of insurance applicable to the additional "property damage" or "personal and advertising insured are those specified in the written contract, injury" caused, in whole or in part, by: written agreement or written permit or in the Decla- rations for this policy, whichever is less. These lim- a. Your acts or omissions; or its of insurance are inclusive of, and not in addition b. The acts or omissions of those acting on your to, the Limits of Insurance shown in the Declara- behalf. tions for this policy. A person's or organization's status as an addi- 4. Coverage is not provided for "bodily injury," tional insured under this endorsement ends when "property damage," or "personal and advertising your operations for that additional insured are injury" arising out of the sole negligence of the completed. additional insured. 2. With respect to the insurance afforded to these 5. The insurance provided to the additional insured additional insureds, the following exclusions are does not apply to "bodily injury," "property damage," added to item 2. Exclusions of SECTION I-- or "personal and advertising injury" arising out of COVERAGES: an architect's, engineer's or surveyor's rendering of or failure to render any professional services This insurance does not apply to "bodily injury," including: "property damage" or "personal and advertising injury" occurring after: Includes copyrighted material of ISO Properties, Inc., with its permission. Copyright, ISO Properties, Inc., 2004 GLS-150s (7-06) Page 1 of 2 a. The preparing, approving or failing to prepare written contract specifically requires that this insur- or approve maps, shop drawings, opinions, re- ance be primary, ports, surveys, field orders, change orders or When this insurance is excess, we will have no du- drawings and specifications; and ly under SECTION I-COVERAGES to defend the b. Supervisory, inspection, architectural or engi- additional insured against any "suit" if any other in- neering activities. surer has a duty to defend the additional insured against that °suit." If no other insurer defends, we 6. Any coverage provided hereunder will be excess will undertake to do so, but we will be entitled to the over any other valid and collectible insurance avail- additional insured's rights against all (hose other able to the additional insured whether primary, excess, contingent or on any other basis unless a insurers. z AUTHORIZED REPRESENTATIVE DATE Includes copyrighted material of ISO Properties, Inc., with its permission. Copyright, ISO Properties, Inc., 2004 GLS-150s (7-06) Page 2 of 2 Here are Certificates of Insurance. Dee Hughes 971-801-1276 Direct (new) dee@slaterinsurance.com Slater & Associates Insurance, Inc. PO Box 1469, Tualatin, OR 97062 503-624-0466 x1716 503-624-0846 Fax www.slaterinsurance.com