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HomeMy WebLinkAboutInsurance Certificate: Olsson Indusstrial Electric Inc. D05/10/2018DiYYYV) A4C"R" CERTIFICATE OF LIABILITY INSURANCE F -ATE 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. 1301 5th Avenue, Suite 1900 (A/C, No. Exti: AC No): Seattle, WA 98101 E-MAIL Attn: Bev Wold; (206) 214-3008 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# _ 21340 -NAES-GAWUE-18-19 INSURER A : Zurich American Insurance Company 16535 INSURED Olsson Industrial Electric Inc INSURER B : American Zurich Insurance Co. 40142 . 1180 NW Maple Street, Suite 200 INSURER C : ACE Property And Casual Ins Co 20699 Issaquah, WA 98027 INSURER D : Berkley Assurance Company INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: SEA-003270810-22 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 ADDLSUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDD/YYYY MMIDDYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY GL05574116-04 05/20/2017 05/20/2018 EACH OCCURRENCE $ 1,000,000 DAMAGE CLAIMS-MADE ~ OCCUR PREM SESOE. oclcurrrence $ 1,000,000 X SIR $200,000 MED EXP (Any one person) $ 10,000 PERSONAL& ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO ❑ LOC PRODUCTS - COMP/OP AGG $ 2,000,000 JECT OTHER: $ A AUTOMOBILE LIABILITY BAP9830191-07 05/20/2017 05/20/2018 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY Per accident COMP/COLL DIED $ 5,000 X UMBRELLA LIAR OCCUR XOC 627833238003 05/20/2017 05/20/2018 EACH OCCURRENCE $ 1,001).00 EXCESS LIAB X CLAIMS MADE AGGREGATE $ DED X RETENTION $ 1 000 000 $ B WORKERS COMPENSATION WC5574117-04(AOS) 05/2012018 X PER OTH- AND EMPLOYERS' LIABILITY STATUTE ER B ANYPROPRIETOR/PARTNER/EXECUTIVE Y / N WC5574118-04 (WI) 05/20/2017 05120/2018 E1 EACH ACCIDENT $ 1,000,000 . OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ D Professional Liability PCAB-5001981-0517 0512012011 0512012018 Limit: $2,000,000 SIR: $200,000 DESCRIPTION OF OPERATIONS I LOCATIONS / 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 included as additional insured where required by written contract and allowed by law with respect to General Liability, Automobile Liability, and Umbrella Liability. This insurance shall be primary and non-contributory and limited to liability arising out of the operations of the named insured when required by written contract, with respect to Genera Liability, Automobile Liability, and Umbrella Liability. 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 Mars;i USA Inc. Beverly A. Wold ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD