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HomeMy WebLinkAboutInsurance Certificate:Pape' Machinery, inc l ACC7l2°® CERTIFICATE OF LIABILITY INSURANCE F D03/01/2018DIYYYY) 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 CONTACT MARSH USA INC. NAME: _ PHONE FAX 111 SW COLUMBIA, STE. 500 IA/C. No Extl A/C No): PORTLAND, OR 97201 E-MAIL Attn: Amy Shafer 503-248-4857 ADDRESS: INSURERS AFFORDING COVERAGE NAIC # CN101920225-STND-GAWU-18-19 PMACH INSURER A : National Union Fire Insurance Company 19445 INSPAPP MACHINERY. INC. INSURER e : N/A N/A C/O THE PAPE' GROUP INSURER C : NIA N/A PO BOX 407 INSURER D : N/A N/A EUGENE, OR 97440 INSURER E : N/A N/A INSURER F : Navigators Insurance Company 42307 COVERAGES CERTIFICATE NUMBER: SEA-003202239-56 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 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 POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDD/YYYY MM DD YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY GL 5180113 03/01/2018 03/01/2019 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE 1XI OCCUR PREM SESOEa :Ncur ence $ 250,000 X CONTRACTUAL LIAB MED EXP (Any one person) $ 25,000 X PER PROJECT AGG $2M PERSONAL 8 ADV INJURY $ 100,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 10,000,000 X POLICY [ X ] PE 0 D LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER $ CA 2961543 03/01/2018 03101/2019 COMBINED SINGLE LIMIT $ 3,000,000 A AUTOMOBILE LIABILITY Ea accident F X ANY AUTO NY18FXR8379531V 03/01/2018 03/01/2019 BODILY INJURY (Per person) $ X OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB _ CLAIMS-MADE AGGREGATE $ DID RETENTION $ $ WORKERS COMPENSATION PER PER EMPLOYERS' LIABILITY Y / N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE. THE CITY OF ASHLAND, OREGON, AND ITS ELECTED OFFICIALS, OFFICERS AND EMPLOYEES ARE INCLUDED AS ADDITIONAL INSUREDS WHEN REQUIRED BY WRITTEN AGREEMENT OR CONTRACT AS RESPECTS TO OPERATIONS OF THE NAMED INSURED. 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. Raymond M. Schneider ~ays,+~✓~C,1~J ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN101920225 LOC Portland ,a►`oRO ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED MARSH USA INC. PAPEMACHINERY, INC. C/O THE PAPEGROUP POLICY NUMBER PO BOX 407 EUGENE, OR 97440 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers' Compensation (continued): Policy #483762 (OR) Insurer: SAIF Effective Date: 0110112018 Expiration Date: 0110112019 Workers' Compensation: Statutory Limits Employer's Liability: $1,000,000 Each Accident I $1,000,000 Disease - Each Employee I $1,000,000 Disease - Policy Limit ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD