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Home My WebLink AboutInsurance Certificate: S&S Sheeetmetal inc. FEDEMTED INSURANCEqF® To Whom It May Concern, RE: S & S SHEETMETAL INC Enclosed is a certificate of insurance that has been renewed for a new policy term. If a copy of an additional insured or policy endorsement was requested, the document will be sent in a separate envelope. If you have any questions regarding this please contact: the Federated Insurance Client Contact Center at: Phone: 1-888-333-4949 Fax: 507-446-4664 E-mail: clientcontactcenter@fedins.com Thank you, Client Contact Center Federated Insurance Companies Enclosed: Certificate of Insurance MISC-0974 (04-13) i 3113/3n3rzo018 ,6 , 66 O CERTIFICATE OF LIABILITY INSURANCE 0 DATE 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 endorsements . PRODUCER CONTACT FEDERATED MUTUAL INSURANCE COMPANY NAME: CLIENT CONTACT CENTER HOME OFFICE: P.O. BOX 328 [AOC, NO Ext : 888-3334949 FAc No : 507-4464664 OWATONNA, MN 55060 E-MAIL ADDRESS: CLIENTCONTACTCENTER FEDINS.COM INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 343.547.6 INSURER B: S & S SHEETMETAL INC INSURER C: 912 ANTELOPE RD WHITE CITY, OR 97503-1607 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 126 REVISION NUMBER: 0 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 DL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD MM/DD/YYYY MMIDDIYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE Fx1 OCCUR PREMISES Ea occurrence $100,000 MED EXP (Any one person) EXCLUDED A Y Y 9910853 04/24/2018 04/24/2019 PERSONAL & ADV INJURY $1,000,000 GEWL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 HPOLICY JECOT ❑ LOC PRODUCTS - COMPIOP AGG $2,000,000 OTHER: AUTOMOBILE LIA131LITY COMBINED SINGLE LIMIT $1,000,000 Ea accident X ANY AUTO BODILY INJURY (Per person) OWNED AUTOS ONLY SCHEDULED A AUTOS Y N 9910853 04/24/2018 04/24/2019 BODILY INJURY (Per accident) HIRED AUTOS ONLY NON-OWNED AUTOS ONLY PROPERTY DAMAGE Per accident) X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $1,000,000 A EXCESS LIAB CLAIMS-MADE N N 9910854 04/24/2016 04/24/2019 AGGREGATE $1,000,000 DED RETENTION WORKERS COMPENSATION PER STATUTE OT"- AND EMPLOYERS' LIABILITY ER YIN ANY PROPRIETORIPARTNERIEXECUTIVE ❑ E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below E.L DISEASE • POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) SEE ATTACHED PAGE CERTIFICATE HOLDER CANCELLATION 343-547-6 1260 THE CITY OF ASHLAND OREGON SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 E MAIN ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ASHLAND, OR 97520-1814 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE v 4, O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 343-547-6 LOC ACORO® ADDITIONAL REMARKS SCHEDULE Page Of AGENCY NAMEDINSURED FEDERATED MUTUAL INSURANCE COMPANY S & S SHEETMETAL INC POLICY NUMBER 912 ANTELOPE RD SEE CERTIFICATE # 126.0 WHITE CITY, OR 97503-1607 CARRIER NAIC CODE SEE CERTIFICATE # 126.0 EFFECTIVE DATE: SEE CERTIFICATE # 126.0 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE CERTIFICATE HOLDER NAME IS AMENDED TO READ THE CITY OF ASHLAND, OREGON ITS ELECTED OFFICIALS, OFFICERS & EMPLOYEES. PROJECT: HVAC SYSTEM INSTALL - NO. MOUNTAIN SHOP EFFECTIVE 07/28/14 THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, LESSORS OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU ENDORSEMENT FOR GENERAL LIABILITY. INSURANCE PROVIDED BY THE GENERAL LIABILITY COVERAGE IS PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE. GENERAL LIABILITY CONTAINS A WAIVER OF SUBROGATION IN FAVOR OF THE CERTIFICATE HOLDER SUBJECT TO THE CONDITIONS OF THE BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY ENDORSEMENT. EACH CONSTRUCTION PROJECT AS REQUIRED BY WRITTEN CONTRACT OR WRITTEN AGREEMENT. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED BY CONTRACT ENDORSEMENT FOR BUSINESS AUTO LIABILITY. i ACORD 101 (2008101) O 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD I