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HomeMy WebLinkAboutInsurance Certificate: Ashland Medford Plumbing Inc. 03/16/2018 6:20:56 AM 507-455-5200 Page 1 FEDERATEDINSURANCE 121 East Park Square P.O. Box 328 Owatonna, MN 55060-0328 Phone: (507) 455-5200 or 800-533-0472 FAX COVER SHEET TO: 541 48853 1 1 @fedfax.com DATE: 03/ 1 6120 1 8 SUBJECT: Certificate Of Insurance - ASHLAND MEDFORD PLUMBING INC 358-611-2 Req 278 The information contained in this facsimile message is intended only for the personal and confidential use of the designated recipient(s) named above. This message may be an attorney-client or work product communication which is privileged and confidential. It may also contain protected health information that is protected by federal law. If you have received this communication in error, please notify us immediately by telephone and destroy (shred) the original message and all attachments. Any review, dissemination, distribution or copying of this message by any person other than the intended recipient(s) or their authorized agents is strictly prohibited. Thank you. 03/16/2018 6:20:58 AM 507-455-5200 Page 2 FAX FEDERATED INSURANCE COMPANIES CLIENT CONTACT CENTER Phone:1-888-333-4949 Fax: 507-446-4664 Email: clientcontactcenter r@i fedins.com Company: City of Ashland Account Number: 358-611-2 Subject: Certificate Of Insurance Message: Thank you for contacting Federated's Client Contact Center. If you have further questions, please contact the Client Contact Center at the telephone number, fax number, or e-mail listed above. 03/16/2018 6:21:00 AM 507-455-5200 Page 3 o3/1s/zola Aco CERTIFICATE OF LIABILITY INSURANCE DA 03/1 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 NAME: CLIENT CONTACT CENTER FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE: P.O. BOX 328 A CNNo Ext : 888-333-4949 FAC No : 507-446-4664 OWATONNA, MN 55060 E-MAIL ADDRESS: CLIEN7CON7ACTCEN7ER FEDINS.COM INSURER(SI AFFORDING COVERAGE NAIC Yr INSURER A: FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 358-611-2 INSURER B: ASHLAND MEDFORD PLUMBING INC INSURER C: PO BOX 8494 MEDFORD, OR 97501-0894 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 175 REVISION NUMBER: 1 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 SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD MMIDDIYYYY MMIDD/YYVY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE I X 1 OCCUR PREMISES Ea oc u rence $100,000 MED EXP (Any one person) EXCLUDED A Y N 9337481 0312012017 03/2012018 PERSONAL & ADV INJURY $1,000,000 OEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000 X POLICY ❑ PRO ❑ LOC PRODUCTS - COMPfOP AGO $2,000,000 JECT OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 Ea accident X ANY AUTO BODILY INJURY (Per person) OWNED AUTOS ONLY SCHEDULED A AUTOS Y N 9337481 03/2012017 03/2012018 BODILY INJURY (Per accident) HIRED AUTOS ONLY NON-OWNED PROPERTY DAMAGE AUTOS ONLY Per a.,,,an X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $2,000,000 A EXCESS LIAB CLAIMS-MADE N N 9337482 03/20/2017 03/2012018 AGGREGATE $2,000,000 ICED RETENTION WORKERS COMPENSATION PER STATUTE OTH- ER AND EMPLOYERS' LIABILITY Y / N ❑ E.L. EACH ACCIDENT ANY PROP RIETORlPARTNERfEXECUTIVE OFFICERIMEMBER EXCLUDED? N /'4 E.L. DISEASE - EA EMPLOYEE (Mandatory in NHI 11 yes, describe under DESCRIPTION OF OPERATIONS below E.L DISEASE -POLICY LIMIT i DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) SEE ATTACHED PAGE CERTIFICATE HOLDER CANCELLATION 358-611-2 1751 CITY OF ASHLAND 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 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD i 03/16/2018 6:21:02 AM 507-455-5200 Page 4 AGENCY CUSTOMER ID: 358-611-2 LOC 4: _ ACORO® ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMEDINSURED FEDERATED MUTUAL INSURANCE COMPANY ASHLAND MEDFORD PLUMBING INC POLICY NUMBER PO BOX 8494 SEE CERTIFICATE # 175.1 MEDFORD, OR 97501-0894 CARRIER NAIC CODE SEE CERTIFICATE # 175.1 EFFECTIVE DATE: SEE CERTIFICATE # 175.1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE INSURANCE PROVIDED BY THE GENERAL LIABILITY COVERAGE IS PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU ENDORSEMENT FOR GENERAL LIABILITY. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED BY CONTRACT ENDORSEMENT FOR BUSINESS AUTO LIABILITY. INSURANCE PROVIDED BY THE BUSINESS AUTO LIABILITY IS PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE. FOR REASONS OTHER THAN NON-PAYMENT OF PREMIUM, 30 DAYS NOTICE WILL BE PROVIDED TO THE CERTIFICATE-HOLDER IN THE EVENT THAT THE ISSUING COMPANY CANCELS THE POLICY BEFORE THE EXPIRATION DATE OF THE POLICY. CITY OF ASHLAND AND ITS ELECTED OFFICIALS, OFFICERS, EMPLOYEES, ARE LISTED AS ADDITIONAL INSURED ON ANY INSURANCE POLICES EXCLUDING WORKERS COMPENSATION REQUIRED HEREIN BUT ONLY WITH RESPECT TO CONTRACTORS SERVICES TO BE PROVIDED UNDER THIS CONTRACT ACORD 101 (2008/01) ® 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD