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HomeMy WebLinkAboutInsurance Certificate: Evergreen Job & Safety Training i } ACORD.M CERTIFICATE OF LIABILITY "INSURANCE DATE(MM/DD/YY) 1113117 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE Hays Companies DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE 80 S 8th Street, Suite 700 POLICIES BELOW. Minneapolis, MN 55402 INSURERS AFFORDING COVERAGE NAIC # Email: programs@hayscompanies.com INSURER A: Certain Underwriters at Lloyds PHONE NO. 1-888-767-2159 FAX NO. 612-373-7270 INSURER B: INSURED INSURER C: Evergreen Job 8r Safety Training, Inc. 1352 Palmerston Loop INSURER D: Roseville, CA 95678 INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR INSRD DATE (MM/DD/YY) DATE (MWDD/YY) GENERAL LIABILITY EACH OCCURRENCE 2000000 X X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 100000 PREMISES Ea occurrence X CLAIMS MADE OCCUR MED EXP (Any one person) 2500 A General Liability 1702MFA003981 2/05/2017 02/05/2018 PERSONAL & ADV INJURY 2000000 GENERAL AGGREGATE 4000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG EXCLUDED X POLICY PROJECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea Accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per Person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per Accident) PROPERTY DAMAGE (Per Accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT ANY AUTO EA ACC OTHER THAN AUTO ONLY, AGG EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE OCCUR F__j CLAIMS MADE AGGREGATE R DEDUCTIBLE RETENTION WC STATU- OTH- WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS' LIABILITY E.L. EACH ACCIDENT ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. DISEASE - EA EMPLOYEE OFFICER/MEMBER EXCLUDED? If yes, describe under E.L. DISEASE - POLICY LIMIT SPECIAL PROVISION BELOW OTHER A Professional (E&O) Liability 1702MFA003981 2/05/2017 02/05/2018 Each Claim + 2000000 Aggregate 14000000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS THIS CERTIFICATE OF INSURANCE SERVES ONLY AS EVIDENCE OF COMBINED PROFESSIONAL AND GENERAL LIABILITY COVERAGE. CERTIFICATE HOLDER IS ADDITIONAL INSURED PER THE FOLLOWING ENDORSEMENT. CERTIFICATE HOLDER ADDITIONAL INSURED; INSURER LETTER: CANCELLATION City of Ashland 90 N. Mt. Ave SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Ashland, OR 97520 EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POICY PROVISIONS. AUTHORIZED SIGNATURE 4~_ ACORD 25 (2001108) © ACORD CORPORATION 1988-2009 ADDITIONAL INSURED ENDORSEMENT Insured: Evergreen Job & Safety Training, Inc. Policy Number: 1702MFA003981 Effective Date: 1/13/17 at 12:01 a.m. standard time It is hereby understood and agreed that for the additional premium charged, the following is added to the policy as an Additional insured with respect to claims arising out of services performed by the insured on their behalf: City of Ashland 90 N. Mt. Ave Ashland, OR 97520 ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. Date: January 13, 2017 BY: HAYS AFFINITY A MEMBER OF HAYS COMPANIES