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HomeMy WebLinkAboutInsurance Certificate: Electric Power Systems AC DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 12/21/2016 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: Parker, Smith & Feek, Inc. PHONE 907-562-2225-FAX 907-561-2504 3800 Centerpoint Drive A/c NoExt): (A~c No): E-MAIL Suite 601 ADDRESS: Anchorage, AK 99503 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Evanston Insurance Company INSURED INSURER B : Alaska National Ins. Co. Electric Power Systems Inc. - 3305 Arctic Blvd., Suite 201 INSURER C : Anchorage, AK 99503 INSURER D 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR IN SR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A GENERAL LIABILITY 16PKGWE00294 12/1/2016 12/1/2017 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTE X COMMERCIAL GENERAL LIABILITY X P REMISES (Ea occur ence $ 50,000 CLAIMS-MADE I " OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2+000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS -COMP/OP AGG $ 2,000,000 POLICY X E ° Loc WA Stop Gap $ 1,000,000 B AUTOMOBILE LIABILITY 16LAS59601 COMBINED SINGLE LIMIT 1,000,000 12/1/2016 1 12/1/2017 '_-JEa accident) $ I X ANY AUTO X BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ $ A UMBRELLA LIAB X OCCUR 16EFXWE1000404 12/1/2016 12/1/2017 EACH OCCURRENCE $ 1,000,000 L EXCESS LIAB CLAIMS-MADE EX over GL/CPUPL only AGGREGATE $ 1,000+000 DED X RETENTION $ 0 $ B WORKERS COMPENSATION 16LWS59601 WC STATU- OTH- AND EMPLOYERS' LIABILITY Y/ N 12/1/2016 12/1/2017 XTORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N / A E L. EACH ACCIDENT $ 1 +000,000 (Mandatory in NH) 1,000,000 E.L. DISEASE - EA EMPLOYEE $ If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ A Professional Liability 16PKGWE00294 $1,000,000 occurrence/$2,000,000 aggregate 12/1/2016 12/1/2017 I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) INSR: **Evanston Insurance Company I INS TYPE: Pollution Liability POLICY NUMBER: 16PKGWE00294; Contractors Pollution Liability 12/1/2016 - 12/1/2017 1 LIMITS: $1,000,000 occurrence/$2,000,000 aggregate RFP - Engineering Services... (See Attached Description) 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, Oregon and its elected ACCORDANCE WITH THE POLICY PROVISIONS. officials, officers and employees 20 East Main Street AUTHORIZED REPRESENTATIVE Ashland, OR 97520 © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 2 of 6 ENGISOLU (SEJ00) DESCRIPTIONS (Continued from Page 1) City of Ashland, Oregon and its elected officials, officers and employees are Additional Insureds and coverage is Primary and Non-contributory on the General Liability and Automobile policies per the attached endorsements/forms. "THIS IS EVIDENCE OF INSURANCE PROCURED AND DEVELOPED UNDER THE ALASKA SURPLUS LINES LAW, AS 21.34. IT IS NOT COVERED BY THE ALASKA INSURANCE GUARANTY ASSOCIATION ACT, AS 21.80. "Surplus Lines Broker for Company A: Worldwide Facilities, LLC License #9718 "Surplus Lines Broker for Company Evanston Insurance Company: Worldwide Facilities, LLC License #9718 3 of 6 ENGISOLU (SEJ00) ,Alaska National INSURANCE COMPANY BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM Various provisions in this endorsement restrict SECTION IV - Business Auto Conditions, coverage. Read the entire policy carefully to Paragraph A. S. - Transfer of Rights of Recovery determine rights, duties, and what is and is not Against Others To Us is amended to include: covered. 5. Transfer of Rights of Recovery Against Throughout this policy, the words "you' and "your" Others to Us refer to the Named Insured shown in the Declarations. The words "we", "us", and "our" refer to This condition does not apply to any the company providing this insurance. person(s) or organization(s) to the extent that subrogation against that person or Other words and phrases that appear in quotation organization is waived prior to the "accident" marks have special meaning. Refer to SECTION V - or the "loss" under a contract with that person DEFINITIONS in the Business Auto Coverage Form. or organization. The coverages provided by this endorsement apply SECTION 11 - COVERED AUTO LIABILITY per "accident" and, unless otherwise specified, are COVERAGE, Paragraph A.2.a. (2) - Supplementary subject to all of the terms, conditions, exclusions and Payments is replaced by the following: deductible provisions of the policy, to which it is attached. (2) Up to $10,000 for cost of bail bonds (including bonds for related traffic law SECTION II - COVERED AUTO LIABILITY violations) required because of an COVERAGE, Paragraph A.1. Who Is An Insured is waccident" we cover. We do not have amended to include: to furnish these bonds. d. Any "employee" of yours while operating SECTION 11 - COVERED AUTO LIABILITY an "auto" hired or rented under a COVERAGE, Paragraph A,2-a. (4) - Supplementary contract or agreement in an "employee's" Payments is replaced by the following: name, with your permission, while performing duties related to the conduct (4) All reasonable expenses incurred by of your business. the "insured" at our request, including actual loss of earnings up to $500 a e. Any person or organization for whom you day because of time off from work. have agreed in writing to provide insurance such as is afforded by this Coverage Form, but only with respect to liability arising out of the ownership, maintenance or use of "autos covered by this policy. If such person or organization has other insurance then this insurance is primary to and we will not seek contribution from the other insurance. ANIC CA 1150 10 13 Page 1 of 4 COMMERCIAL GENERAL LIABILITY oil MARKET EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM A. Section 11 - Who Is An Insured is amended to include as an additional insured any person(s) or organization(s) to whom the insured agrees to provide additional insured status in a written contract, provided such written contract is signed by both parties and executed prior to the commencement of operations, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions, or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" "property damage", or "personal and advertising injury" occurring after: 1. All work on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured at the location of the covered operations, including materials, parts or equipment furnished in connection with such work, has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. nth respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits Of insurance shown in the Declarations: whichever is less. This endorsement will not increase the applicable Limits Of Insurance shown in the Declarations. All other terms and conditions remain unchanged. MEGL 1542 45 16 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. ENVIRONMENTAL MARKET: EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTOMATIC PRIMARY AND NON-CONTRIBUTORY INSURANCE This endorsement modifies insurance provided under the following, where indicated by an "X" in the checkbox below- (2] COMMERCIAL GENERAL LIABILITY COVERAGE FORMA Ej CONTRACTOR'S POLLUTION LIABILITY COVERAGE FORM ❑ OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE FORM ❑ PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE FORM SCHEDULE Person Or Organization, Any additional insured with whom you agree in a written contract signed by both parties and executed prior to the commencement of operations to provide Primary and Non-Contributory status under this insurance. With respect to the coverage provided by this endorsement, the following is added to the Other Insurance condition of the Coverage Form(s) indicated above Primary And Non-Contributory This insurance is primary to, and will not seek contribution from, any other insurance available to the Person Or Organization shown in the Schedule of this endorsement. However, this does not apply to any "claim", "suit" or "pollution condition" resulting from the sole negligence of the Person Or Organization shown in the Schedule of this endorsement. All other terms and conditions remain unchanged. MEET 2274 05 16 Includes copyrighted material of Insurance Services Office, Inc_, Page 1 of 1 with its permission. City of Ashland, Oregon and its elected officials, officers and employees 20 East Main Street Ashland, OR 97520 1 of 6 ENGISOLU (SEJ00)