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HomeMy WebLinkAboutInsurance Certificate: Olsson Industrial Electric (2) DATE (MMlDDIYYYY) Aco~r°® CERTIFICATE OF LIABILITY INSURANCE 0511512017 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 Marsh USA Inc. NAME: _ 13015th Avenue, Suite 1900 lAic No, Ext): _ ~N1_ Seattle, WA 98101 E-MAIL Attn: Seattle CertRequest@marsh.com 1 F:212-948-4326 ADDRESS: _ _ INSURER{S) AFFORDING COVERAGE NAIC # 21340 -NAES-GAWUE-17-18 _ _ _ INSURER A :Zurich American Insurance Company 16535 INSURED American Zurich Insurance Co. 40142 Olsson Industrial Electric Inc. INSURER B : 1180 NW Maple Street, Suite 200 INSURER c :ACE Property And Casualty Ins Co _ 20699 Issaquah, WA 98021 INSURER D :Berkley Assurance Company INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: SEA-003080485-17 REVISION NUMBER:3 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 OTf-IER DOCUMENT WITH RESPECT- TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED FtEREIN 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 _ J MN!!DD YYYY MMI D YYYY LIMITS LTR A X COMMERCIAL GENERAL LIABILITY GL05574116-04 0512012011 0512012018 EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED ,CLAIMS-MADE ~ OCCUR PREMISES (Ea occurrence $ _ 1,000,000 X SIR $200,000 _MED EXP (Any one person) _ $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL_AGGREGATE $ 2,000,000 X POLICY ~ PRO ~ LOC PRODUCTS - COMPIOP AGG $ __2,000,000 JECT 1 OTHER: $ A AUTOMOBILE LIABILITY BAP9830191-07 0512012017 0512012018 COMBINED SINGLE LIMIT $ 1,000,000 Ea accident, X~ P~!~ AUTO I BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ _ HIRED AUTOS AUTOS Per accidenl~_______ COMPICOLL DED $ 5,000 ~ X UMBRELLA LIAB OCCUR XOC 627833238003 05120!2017 0512012018 EACH OCCURRENCE $ 1,000,000 EXCESS LIAB X CLAIMS-MADE AGGREGATE $ DED X RETENTION $1;000,000 $ B WORKERS COMPENSATION WC5574117-04(AOS) 0512012011 0512012018 X PER oTH- AND EMPLOYERS' LIABILITY _STATUTE ER_ _ B ANY PROPRIETORlPARTNERlEXECUTIVE Y! N WC5574118-04 (WI) 0512012017 0512012018 E.L. EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? a N ! A (Mandatory in NH) E L DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below El DISEASE -POLICY LIMIT $ D Professional Liability PCAB-5001981-0517 0512012017 0512012018 I Limit: $2.000,000 SIR: $200,000 DESCRIPTION OF OPERATIONS! LOCATIONS! VEHICLES {ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Ashland, Oregon and its elected officials, officers and employees are included as additional insured where required by written contract and allowed bylaw with respect to General Liability, Automobile Liability, and Umbrella Liability, This insurance shall be primary and non-contributory and limited to liability arising out of the operations of the Warned insured when required by written contract, with respect to Genera Liability, Automobile Liability, and Umbrella Liability. CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 East Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Ashland, OR 97520 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Beverly A. Wold ~ ©1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD