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HomeMy WebLinkAboutInsurance Certificate: Pape Machinery 212 345-5000 3/7/2017 3:31:51 PM PAGE 2/003 Fax Server a DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 03/07/2017 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: MARSH USA INC PHONE FAX 111 SW COLUMBIA, STE 500 A/C No Ext : A/C No : PORTLAND, OR 97201 E-MAIL Ath Amy Shafer 503-248-4857 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # 900810-STND-GAWU-17-18 PMACH INSURER A : National Union Fire Insurance Company 19445 INSURED INSURER B : N/A N/A PAPE' MACHINERY, INC. C/O THE PAPE' GROUP INSURER C : N/A N/A PO BOX 407 INSURER D : N/A N/A EUGENE, OR 97440 INSURER E : N/A, N/A INSURER F : Navigators Insurance Company 42307 COVERAGES CERTIFICATE NUMBER: SEA-002625511-52 REVISION NUMBER:3 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- ADDL SUBR POLICY EFF POLICY EXP LTINSR R TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY GL 5180113 03/01/2017 1103/01/2018 EACH OCCURRENCE $ 1,000,300 70 _7 CLAIMS-MADE E OCCUR PREDAMMIAGESES S ( Ea occurrence) $ 250,000 X CONTRACTUAL LIAR MED EXP (Any one person) $ 25,300 PERSONAL & ADV INJURY $ 1,000,300 X PER LOC AGG $2M GEN L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 10,000,900 X POLICY ❑ PRO- ~J LOC PRODUCTS - COMP/OP AGG $ 2,000,900 JECT I,-J OTHER: $ A AUTOMOBILE LIABILITY CA 2961543 03101/2017 03/01/2018 COMBINED SINGLE LIMIT $ 3,000,300 Ea accident F X ANY AUTO NY17FXR8379531V 03/01/2017 03/01/2018 BODILY INJURY (Per person) $ X ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS X X NON-OWNED Per OP PROPERTY DAMAGE $ HIRED AUTOS AUTOS - - - UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS LIABILITY Y / N STATUTE ER ANY PROPRIETOR/PARTNER/E'XECUTIVE E. L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L DISEASE-EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE THE CITY OF ASHLAND, OREGON, AND ITS ELECTED OFFICIALS, OFFICERS AND EMPLOYEES ARE INCLUDED AS ADDITIONAL INSUREDS WHEN REQUIRED BY WRITTEN AGREEMENT CR CONTRACT AS RESPECTS TO OPERATIONS OF THE NAMED INSURED- CERTIFICATE HOLDER CANCELLATION CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 EAST MAIN STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ASHLAND, OR 97520 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Raymond M- Schneider ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 212 345-5000 3/7/2017 3:31:51 PM PAGE 3/003 Fax Server AGENCY CUSTOMER ID: 900810 LOC Portland ,4coR© ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED MARSH USA INC. PAPEMACHINERY, INC. C!0 THE PAPE' GROUP POLICY NUMBER PO BOX 407 EUGENE, OR 97440 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers' Compensation (conlinued): Policy #483762 (OR) Insurer: SAIF Effective Date: 0110112017 Expiration Dale: 01/01/2018 Workers' Compensation: Statutory Limits Employer's Liability: $ 1,000,000 Each Accidenl I $1,000,OOC Disease - Each Employee! $1,000,000 Disease - Policy Limit I i ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD