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HomeMy WebLinkAboutInsurance Certificate: S&S Sheetmetal (2) l DATE (MM/DD/YYYY) ACOR" 164.~ CERTIFICATE OF LIABILITY INSURANCE 03/11/2017 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 endorsements . PRODUCER CONTACT NAME: CLIENT CONTACT CENTER FEDERATED MUTUAL INSURANCE COMPANY PHONE HOME OFFICE: P.O. BOX 328 A CNo Ext : 888-333-4949 A/c No : 507-446-4664 E-M OWATONNA, MN 55060 ADDRESS: CLIENTCONTACTCENTER FEDINS.COM INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 343-547-6 INSURER B: S & S SHEETMETAL INC INSURER C: 912 ANTELOPE RD WHITE CITY, OR 97503 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 188 REVISION NUMBER: 0 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 LTR INSR WVD MM/DD/YYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE Fx~ OCCUR PREMISES Ea occurrence) $100,000 MED EXP (Any one person) EXCLUDED A N N 9910853 04/24/2017 04/24/2018 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 [:1 PRO ❑ LOC PRODUCTS - COMP/OP AGG $2,000,000 POLICY X JECT OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $1,000,000 X ANY AUTO BODILY INJURY (Per person) ALL OWNED SCHEDULED A AUTOS AUTOS N N 9910853 04/24/2017 04/24/2018 BODILY INJURY (Per accident) NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $1,000,000 A EXCESS LIAB CLAIMS-MADE N N 9910854 04/24/2017 04/24/2018 AGGREGATE $1,000,000 DED RETENTION WORKERS COMPENSATION PER STATUTE OTH- AND EMPLOYERS' LIABILITY ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED? N ! A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE If yes, describe under E.L DISEASE -POLICY LIMIT DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: 1097 B STREET, ASHLAND OR 97520 CERTIFICATE HOLDER CANCELLATION 343-547-6 1880 CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 90 N MOUNTAIN AVE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ASHLAND, OR 97520-2014 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD