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HomeMy WebLinkAboutInsurance Certificate: Van Row Mechanical VANRO-1 P ID: KA ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 0612712017 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 503-357-7111 NAMEACT Kay Andrew Pacific Insurance Partners PHONE 503-357-7111 Fax 503-359-0340 www.pacificinspartners.com (Alc, No, Ext): (AIC, Nol: P. 0. Box 327 A DRESS: kay@pacificinsparnters.com Forest Grove, OR 97116 Forest Grove House INSURER S AFFORDING COVERAGE NAIC # INSURER A ; Ohlo Security Insurance Co 24082 INSURED Van Row Mechanical Inc INSURER B ;Ohio Casualty Insurance Co 24074 PO Box 3813 INSURER c ; SAIF Corporation 36196 Central Point, OR 97502 INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 SUB POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD MMIDDIYYYY MMIDDIYYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ~ OCCUR X BKS57429208 07!0612017 0710612018 DAMAGE TO RENTED 1,000,000 PREMISES Ea occurrence $ MED EXP An one erson $ 15,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ❑X PE ~ ~ LOC PRODUCTS - COMPIOP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY Per erson $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ B UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 2,000,000 X EXCESS LIAB CLAIMS-MADE US055218728 0710612017 07106!2018 AGGREGATE $ 2,000,000 DED RETENTION $ $ C WORKERS COMPENSATION X STATUTE FOR H AND EMPLOYERS' LIABILITY 760659 0510112017 0510112018 2,000,000 ANY PROPRIETORIPARTNERIEXECUTIVE ~ E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N ~ A 2,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under 2 OOO QOQ DESCP.IPTION OF OPERATIONS be!aw E_L. ~!SEASE -POLICY LIMIT _w_ ' ' ~SCRI TON FOP TIONS I LOCATI S I V HIC ES A R 101, Ad 'tional Remar s Sched le, ma be attached if mores ace is re wired ~ity o~ bsholand,~regon anc>~Nts e~ec~ed o~~iclals, o~~lcers an~ employees p q are additional insureds to the extent of coverage under form CG8810 0413. CERTIFICATE HOLDER CANCELLATION AS H LA-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland, Oregon ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main St Ashland, OR 97520 AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD