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HomeMy WebLinkAboutInsurance Certificate: Electrical Consultants ELECCON-05 CTHELEN Acofrr~ CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YWI) 12/6/2016 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 have ADDITIONAL INSURED provisions or 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 CQNTACT Billings Office PHONE 238-1900 FAX 406 245-9887 PayyneWest Insurance, Inc. WC, No, Ext): (406) (A/C, No):( ) P.O. Box 30638 ADDRESS: Billings, MT 59107-0638 INSURERS) AFFORDING COVERAGE NAIC # INSURERA: National Fire Ins of Hartford 20478 INSURED INSURER B : Continental Ins Co 35289 Electrical Consultants, Inc. INSURER C : Continental Casual Company 120443 3521 Gabel Road INSURER D : Montana State Fund 811212 Billings, MT 59102-7307 INSURER E : Zurich American Insurance Company 16535 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS MADE OCCUR X 6015980113 11/01/2016 11/01/2017 DAMAGE TO RENTED 500000 PREMISES Ea occurrence $ MED EXP An one person $ 15'000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JERCOT- D LOC PRODUCTS - COMP/OP AGG $ 2,000'000 Employee Benefi $ 1,000,000 OTHER: COMBINED SINGLE LIMIT 1,000,000 B AUTOMOBILE LIABILITY Ea accident $ X ,ANY AUTO 6014516577 11/01/2016 11/01/2017 BODILY INJURY Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ HIRED NON OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ C X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 14,000,000 EXCESS LIAR CLAIMS-MADE 6015980127 11/01/2016 11/01/2017 AGGREGATE $ 14,000,000 DED X RETENTION $ $ D WORKERS COMPENSATION X STATUTE EORH AND EMPLOYERS' LIABILITY YIN 032578445 0110112017 01101/2018 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE N N /A E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ 1'000'000 If yes, describe under E.L. DISEASE _ ^CLiCY LI?."fT S 1'000'000 nF.SCRIPTION OF noGRgTIONS helots C Professional Polluti EH114043145 0911012016 0911012017 Per Claim & Aggregat 10,000,000 E Workers Compensation C959744506 01/01/2017 0110112018 See Below DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (aCORD 101, Addltlonal Remarks Schedule, may be attached If more space Is required) Blanket Additional Insured per written contract Including Completed Operations. Primary and Non-Contributory Coverage per written contract. Blanket Waiver of Subrogation per written contract. Blanket additional insured and waiver applies on Auto Coverage per written contract Per forms CNA74705XX, CNA74706XX, CNA74736XX, CNA75079XX, CA0444 and SCA23500D. Worker's Compensation Waiver of Subrogation applies per written contract per form W0000313.. Umbrella is follow form. Blanket Additional Insured applies to Umbrella. "Workers Comp Information for Policy WC959744504 Coverage A States: AZ, CA, CO, FL, ID, MN, MO, NJ, OK, TN, TX, UT, WI SEE ATTACHED ACORD 101 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 East Main Street Ashland, OR 97520 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: ELECCON-05 CTHELEN LOC 1 A ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED fillings Office 3521 Gabel Rod nts, Inc. POUCY NUMBER Billings, MT 59102-7307 EE PAGE 1 CARRIER NAIC CODE EE PAGE 1 SEE P 1 EFFECTIVE DATE: SEE PAGE 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 26 FORM TITLE: Certificate of LIabIIHy Insurance Description of Operations/Locations/Vehicles: Coverage A Statutory Employers Liability Limits for Policy WC969744506: Each Accident: $1,000,0001131sease - Each Employee: $1,000,000JDisease - Policy Limit: $1,000,000 Part 3 Other States Included - All except monopolistic and MT Professional Coverage information: Claims-made Coverage. Deductible Endorsement Ded per claim including claim expenses $350,0000 Named Insured includes: Electrical Consultants, Inc., ECI Engineering Services PC, EPC Services Company: Retro Active Date: 09110198 Policy Number: AEH114043146 All operations performed by the above insured. ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD