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HomeMy WebLinkAboutInsurance Certificate: Potelco ~ 1 ACORD° CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) S/1/2o1s 4/7/2017 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 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 LOCKTON COMPANIES NAME: 5847 SAN FELIPE, SUITE 320 alc, No, Ext : alc, No HOUSTON TX 77057 E-MAIL 866-260-3538 ADDRESS: INSURER S AFFORDING COVERAGE NAIC # INSURER A : Old Re ublic Insurance Com an 24147 INSURED POTELCO, INC. INSURER B : ACE Pro e & Casual Insurance Co 20699 1364742 A QUANTA SERVICES COMPANY INSURER C 14103 STEWART RD. SUMNER WA 98390 INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 12424201 REVISION NUMBER: XXXXXXX 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 CONTRACTOR 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 POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y N MWZY 310349 S/1/2017 S/1/2018 EACH OCCURRENCE S OOO OOO A CLAIMS-MADE OCCUR MWZX 310351 S/l/2017 SI1/2018 DAMAGE TO RENTED S OOO OOO PREMISES Ea occurrence MED EXP An one erson) Excluded PERSONAL & ADV INJURY $ S OOO OOO GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ S OOO OOO POLICY JERD ~ LOC PRODUCTS - COMPIOP AGG $ S OOO OOO OTHER: $ A AUTOMOBILE LIABILITY y N MWTB 310348 S/1/2017 S/l/2018 Ea aBcldeD SINGLE LIMIT $ S OOO OOO A X ANY AUTO MWZX 310347 S/1/2017 S/l/2018 BODILY INJURY (Per person) $ XXXXXXX X ~UTOS ONLY AUTODULED BODILY INJURY (Per accident $ ~~XXX X AUTOS ONLY X AUOTNO ONLDY Pe~accldentDAMAGE $ XX~~~XXX $XXXXXXX B X UMBRELLA LIAB OCCUR N N X00 627972032 002 5/1/2017 S/1/2018 EACH OCCURRENCE $ 5 QOO OOQ EXCESS LIAB CLAIMS-MADE AGGREGATE $ S QOO OOO DED RETENTION $ $ XXXXXXX WORKERS COMPENSATION PER OTH- A AND EMPLOYERS' LIABILITY YIN N MWC 310350 00 S/1/2017 SI1I2018 X STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ~ N ! A E.L. EACH ACCIDENT $ 1 QQQ Q~Q Manld tory in NH) EXCLUDED? E.L. DISEASE - EA EMPLOYEE 1 000 000 If yes, describe under nn DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LlNili i OOU 000 DESCRIPTION OF OPERATIONS !LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: All Operations General Liability And Auto Liability Policies Include The City Of Ashland, Oregon, And Its Elected Officials, Officers And Empployees As An Additional Insured When Required $y Written Contract But Only As Respects Liability Arising Out Of Named Insured's Work For Addrt~onal Insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 12424201 AUTHORIZED REPRESENTATIVE The City Of Ashland, Oregon Attn: Kari Ann Olson 90 N. Mountain Ave. Ashland OR 97520 ACORD 25 (2016103) ©1988-2015 ACORD CORPORATI .All rights reserved The ACORD name and logo are registered marks of ACORD