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HomeMy WebLinkAboutInsurance Certificate: Osmose Utilities Services ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 06129(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 Marsh USA Inc. NAME: PHONE FAX 1560 Sawgrass Corporate Pkwy, Suite 300 C A1C No Sunrise, FL 33323 E-MAIL ADDRESS: INSURER S AFFORDING COVERAGE NAIL # 101142660-GAWU-17-18 INSURER A ;Zurich American Insurance Company 16535 INSURED INSURER B :National Fire & Marine Insurance Co 20079 Osmose Utilities Services, Inc. 635 Highway 74 INSURER C :Navigators Insurance Company 42307 Peachtree City, GA 30269 INSURER D :Everest National Insurance Co 10120 INSURER E :Indemnity Ins Co Of Norfh America 43575 INSURER F COVERAGES CERTIFICATE NUMBER: ATL-004182572-04 REVISION NUMBER:O 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 ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY MMIDDlYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY GL00381439-OZ 0710112017 0710112018 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ~ OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER; Buffer Ilmlt IS GENERAL AGGREGATE $ 2,000,000 POLICY ~ R~ ~ LOC Per OcclAggrlProtl Comp Ops PRODUCTS - COMPlOP AGG $ 2,000,000 C OTHER: NY17EXC903879 IU Buffer 0710112017 0110112018 Buffer: $ 1,000,000 A AUTOMOBILE LIABILITY BAP 0381440-02 0110112017 0710112018 COMBINED SINGLE LIMIT $ 1 Q~~ p~~ Ea accident X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ 6 42-XSF-302666-02 Excess Auto 07!0112017 0710112018 Excess Autombile Limit: $ 1,000,000 D X UMBRELLA LIAR X OCCUR XC3EX00016-171 0710112017 07!01!2018 EgCH OCCURRENCE $ 10,000,000 X EXCESS LIAR CLAIMS-MADE AGGREGATE $ 10,000,000 DED RETENTION $ $ A WORKERS COMPENSATION WC 0381438-02 0710112017 0710112018 X STATUTE I ERH AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YNN NIA E.L. EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EP. EMPLOYEE 1,000,000 If yes, describe under ~ 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ E Excess XSM 646784558 001 (Excess) 0110112017 0710112018 Limit: 15,000,000 Policy is XS of $10,000,000 DESCRIPTION OF OPERATIONS !LOCATIONS 1 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 Additional Insured on a primary and non-contributory basis in regard to the above Liability policies when required by executed written contract. A Waiver of Subrogation is included when required by executed written contract. Workers Compensation coverage is extended to the state of Oregon. CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 90 N. Mountain Avenue THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Ashland, OR 97520 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Sandi Lee ~ ~Q~--~-~-~ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD