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HomeMy WebLinkAboutInsurance Certificate: Automated Valve Services epee Sart i Torre : Automated Ual ve { 15814885311) 08.51 05,'31 s'17 GMT-07 Pg 2-3 AUTOVAL-01 RSARTI ACORD`" DATE (MMlDD1YYYY) CERTIFICATE OF LIABILITY INSURANCE 0513112017 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) musk 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 CONTACT NAME: George Petersen Insurance Agency -Redding PHOldE 530 244-9400 FAx 530 244-9444 2920 Bechelli Lane {Arc, No, EXtI: ( ) (arc, No►:{ ) Redding, CA 95002 AEI RIESS: InfOC~gpinS.COm INSURER S AFFORDING COVERAGE NAIC # INSURER A : Atafn S Clal Insurance Co INSURED INSURER B :Titan Indemnit Com an 13242 Automated Valve Services, Inc. INSURER C 13877 Jody Lane INSURER o Bella Vista, CA 96008 INSURER E ; INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS !S 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 TYPE OF INSURANCE ADDL SUBR pOL1CY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD MMIDDIYYYY MMIDDIYYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR CIP295332 1012112016 1012112017 DAMAGE TO RENTED 1 OO,000 x PREMISES Ea occurrence $ MED EXP An one ersen $ 5'000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ~ PRA ~ LOC PRODUCTS - COMPIOP AGG $ 1,000,000 JECT OTHER: $ B AUTOMOBILE LIABILITY Ea acDcideDISINGLELlMIT $ 1,000,000 ANY AUTO 7417210 09109/2016 09109/2011 BODILY INJURY Per erson $ OWNED X SCHEDULED AUTOS ONLY AUT05 BODILY INJURY Per accident $ HIRED X NON-OWNED PerOacadenfDAMAGE $ AUTOS ONLY AUT05 ONLY UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LlAB CLAIMS-MADE AGGREGATE $ i DED RETENTION ~ $ WORKERS COMPENSATION PER CTH- ANDEMPLOYERS' LIABILITY STATUTE ER YlN ANY PROPRIETORIPARTNERIEXECUTIVE ❑ E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N 1 A (ManQafory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below I E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101, Additions( Remarks Schedule, maybe attached if more space is required) THE CITY OF ASHLAND, AND ITS ELECTED OFFICIALS, OFFICERS, AND EMPLOYEES ARE LISTED AS ADDITIONAL INSUREDS AS PER THE ATTACHED FORM CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE CITY OF ASHLAND THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 E. MAIN STREET ASHLAND, OR 97520 AUTHORIZED REPRESENTATNE ~ ACORD 25 (201fi103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD epee Sart i To : re : Automated Valve ~ 15414885311) 08:51 05/31 / 17 GMT-07 Pg 3-3 COM M ERCIAL G EN I:RAL LIABILITY CG 20 33 0413 THIS ENDORSEMENTCHANGES THE POLICY, PLEASE READ 1T CAREFULLY, ADDITIONALINSURED -OVI►NERS, LESSEES OR CONTRACTORS -AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENTINITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A, &ecflon II -Who Is An Insured is amended to B. With respect to the insurance afforded to these ad- include as an additional insured any person or or- ditional insureds, the following additional exclu- ganization for whom you are performing opera- sions apply: bons when you and such person or organization This insurance does not apply to: have agreed in writing in a contract or agreement that such person or organisation be added as an 1. "Bodily injury", "property damage" or "personal additional insured on your policy. Such person or and advertising injury" arising out of the ren- organization is an additional insured only with re- daring of, or the failure to render, any profes- spect to liability for "bodily injury", "property dam- sional architectural, engineering or surveying age" or "personal and advertising injury" caused, in services, including: whole or in part, by: a, The preparing, approving, or failing to 1. Your acts or omissions; or prepare or approve, maps, shop draw- ings, opinions, reports, surveys, field or- 2. The acts or omissions of those acting on your ders, change orders or drawings and behalf; specifications; or in the performance of your ongoing operations for q. Supervisory, inspection, architectural or the additional insured. engineering activities. However, the insurance afforded to such additional This exclusion applies even if the claims against insured: any insured allege negligence or other wrongdoing 1. Only applies to the extent permitted by law; in the supervision, hiring, employment, training or and monitoring of others by that insured, if the "occur- 2. Will not be broader than that which you are re- rence" which caused the "bodily injury" or "prop- quired by the contract or agreement to provide arty damage", or the offense which caused the for such additional insured, "personal and advertising injury", involved the r~n- dering of or the failure to render any professional A person's or organization's status as an addi- architectural, engineering or surveying services. tional insured under this endorsement ends when your operations for that additional insured are completed. CG 20 33 04 13 Copyright, Insurance Services Office, Inc,, 2012 Page 1 of 2 Sart i To ; re ; Hutomated Va 1 ve (15414885311) 08 ; 51 0531 ~ 17 GMT-07 Pg 1-3 George Petersen Insurance Agency and its Affiliates Note, the information in this E-Mail message is canfidential, It is intended solely far the use of the individuals) named above, If ya~~ are the Intended recipient, Le a~~~vare that your ~~se of any r~nfidential, proprietary and%or personal information may be restricted lay state and federal privacy la~~vs, I` you are not the intended recipient, you should not distrib~~te or fan~vard this E-mail message, If yo~~ have received this E-mail in error, please immediately notify the sender and delete the material from any computer and~ar server,