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HomeMy WebLinkAboutInsurance Certificate: Rh2 Engineering ® DATE (MMIDD/YYYY) A~ D CERTIFICATE OF LIABILITY INSURANCE 5/16/2017 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 Jolla Bolin NAME: Sammamish Insurance, IT1C . E~_ (42~) 898"8780 ~AX (425) 83E-2865 Al~NoZ - 704 228th Ave NE, PLAID 373 a~DRESS:JonaBc~lin@msn.com - - INSURER(5)AFFORDING COVERAGE NAIC # Sammamish WA 98074 _ INSURERA_Ohio _Securit~Insurance Company _ 24082 INSURED INSURER B :Tl'ie Ohio Casualty Insurance -Company 24074 _ Rh2 Engineering Inc INSURER c ;Continental Casualty Co~n~_ _X20443 22722 29th Dr SE Ste 210 INSURER D : _ - - - INSURER E : Bothell WA 98021 INSURER F COVERAGES CERTIFICATE NUMBER:CL1751503054 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELCW 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. INS ADDL SUBR POLICY EFF j POLICY EXP LTR TYPE OF INSURANCE IN D WV POLICY NUMBER MMlDDIYYYY MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY it ~ ~ ,EACH OCCURRENCE $ 2, 000 , 000 I_-- ~ DA GAM E TO RENTED A 1 CLAIMS-MADE ~X OCCUR ~ 'PREMISES (Ea occurrence $ 2 ,_000 , 000 i X ~ BZS.67962270 5/29/2017 5/29/2018 ~MEDEXP-An one erson; $ 15,000 - PER_SONAL & ADV INJURY ; $ 2, 000 , 000 GEN'L AGGREGATE LIMIT APPLIES PER. ,GENERAL AGGREGATE $ 4 , 000 , 000 ~ r__ _ - ~ I j ~ PRO- ~ i $ 4,000,000 X ~ POLICY II LOC PRODUCTS COMP/OP AGG f ~ JECT I~ ~ ~ _ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1, 000, 000 I Ea accident _ _ ~ X 1 I BODILY INJURY (Per person) ~ $ A ANY AUTO _ - - 1 ALL OWNED ~ SCHEDULED i BAS57962270 5/29/201'7 5/29/2018 BODILY INJURY (Per accident) $ 'AUTOS ~ AUTOS ~ - - NON-OWNED I ! PROPERTY DAMAGE _ i $ - HIREDAUTOS AUTOS Per accident _ _ _ _ _-1 UMBRELLA LIAB ~ ;OCCUR ~ EACH OCCURRENCE- - I $ 2, 000_, 000 - I B 'i 'EXCESS LIAB CLAIMS-MADE ~I AGGREGATE , $ 2 000 000 - - - --T- DED X1 RETENTIONS 10,000 US05796227 5/29/2017 5/29/2018 ~ $ PER OTH- ~ ~~EMPLOY~ERSLIABL~ Y/N I STATUTE X _ER__ E.L. EACH ACCIDENT ' $ 2 , 000 , 000 ANY PROPRIETORIPARTNERIEXECUTIVE ~ N OFFICER/MEMBER EXCLUDED? N BZS:~7962270 5/29/2017 5/29/2018 E.L. DISEASE EA Eh1PL0YE $ 2 ,_000 , 000 A j (Mandatory in NH) _ - - - - - - - If yes, describe urdar I DESCRIPTION OF OPERATIONS below I E.L. DISEASE -POLICY LIMIT $ 2 000 000 C Professional Liability F>EHOC9312321 5/29,'2017; 5/29/2018 ~ PerClaim $3,000,000 Claims Made ~ 1 Deductible $200, 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Ashland is named as additional insured. CERTIFICATE HOLDER ~ CANCELLAThJN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELnVERED IN 520 N Main St. ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE A Fugitt CPC7!JON_A ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 r~man~ i