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HomeMy WebLinkAboutInsurance Certificate: HazmatIQ by Federal Resources _ 186023 AC R CERTIFICATE DATE (MM/DD/YYYY) oC 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(ies) 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 C NAME: ONTACT Debbie Archimbaud Commercial Lines - (919) 676-8834 PHONE FAx (A/C, No, Ext); 919-334-2605 (A/C, No): Wells Fargo Insurance Services USA, Inc. E-MAIL ADDRESS: debbie.archimbaud@wellsfargo.com 8540 Colonnade Center Drive, Suite 111 INSURER(S) AFFORDING COVERAGE NAIC # Raleigh NC 27615 INSURER A: Great Northern Insurance Company 20303 INSURED INSURER B: Granite State Insurance Company HazmatlQ by Federal Resources C . Indian Harbor Insurance Company 23809 INSURER 36940 235-G Log Canoe Circle INSURER D : INSURER Stevensville MD 21666 INSURER F COVERAGES CERTIFICATE NUMBER: 11148989 REVISION NUMBER: See below 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 LTR TYPE OF INSURANCE POLICY NUMBER MM/DDYYYY MMIDD YYYY LIMITS COMMERCIAL GENERAL LIABILITY j EACH OCCURRENCE S 1,000.000 A 35894855 12/01/2016 12/01/2017 X RENTED _ DAMAGE TO CLA{N1S MADE OCCUR 1 000.000 PREMISES (Ea occurrence) i S MFD FXP (Any one person) S 10,000 PERSONAL & ADV INJURY i S 1.000 ,000 i GFN'I AGGRFGATF OMIT APPLIFS PFR GENERAL AGGREGATE S 2.000.000 X PRO POLICY ! JEC1 LOC PRODUCTS - COMP/OP AGG S 2.000.000 OTHER: 5 A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 73587445 12/01/2016 12/01/2017 E a ac c+dent S 1, 000.000 X ANY AU10 _ BODILY INJURY (Per person) S OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Peraccident) S ' HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) ~~J~ I S UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAR ' CLAIMS MADE - - AGGRFGATF S DED RETENTION S S IWORKERS COMPENSATION 02/16/2016 02/16/2017 X PER X OTH- USL&H B SAND EMPLOYERS' LIABILITY Y / N ! WC13673775 STATUTE R.___.____~__ ANYPROPRIETOR/PARTNER/EXECUTIVE I 1 000 000 E L EACH ACCIDENT I OFFICERWEMBER EXCLUDED? NIA' (Mandatary in NH) 1,000,000 E.L. DISEASE - EA EMPLOYFE S If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT S 1.000.000 C Professional Liability MTP0041276 0211612016 12/01/2017 $2,000.000 per occurrence $2.000.000 aggregate i DESCRIPTION OF OPERATIONS / LOCATIONS ! VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached if more space is required) The City of Ashland, Oregon is included as additional insured for General Liability, Automobile Liability, and Professional Liability as their interest may appear as required by written contract. General Liability, Automobile Liability, and Professional Liability coverage is primary and non-contributory. CERTIFICATE HOLDER CANCELLATION The City of Ashford, Oregon SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 East Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE The ACORD name and logo are registered marks of ACORD ©1988-2415 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 1111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 -cYa01A05ro00097r02r02im0!0ro* Commercial Lines - (919) 676-8834 Wells Fargo Insurance Services USA, Inc. 8540 Colonnade Center Drive, Suite 111 Raleigh, NC 27615 The City of Ashford, Oregon 20 East Main Street Ashland, OR 97520 Would you like to receive this certificate via email or fax? We offer expedited delivery to better serve our mutual clients. To update the delivery method for revisions to this certificate and for next year's copy, please enter this information in your browser: https://www.cybersure.com/cybersure/forms/iyoc/cdmu.aspx When prompted, enter this information for security purposes: Client ID: 186023 Cert I D: 11148989 Passcode: A28520BE Follow the instructions and let us know your delivery preference. You'll receive future copies of this certificate via the method you provide. Thank you for helping us provide certificates to you more quickly. 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