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HomeMy WebLinkAboutInsurance Certificate: F.D. Thomas, Inc ' 1 ® DATE (MM/DD/YYYY) ACORO CERTIFICATE OF LIABILITY INSURANCE 05/2912018 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 1031 W. 4th Avenue _WC, No- Ext): A/c No : Suite 400 E-MAIL Anchorage, AK 99501 ADDRESS: Attn: Seattle.certrequest@marsh.com / FAX 212-948-4326 INSURERS AFFORDING COVERAGE NAIC # INSURER A : ACE American Insurance Company 22667 INSURED F.D. Thomas, Inc INSURER 8 : ACE Property And Casual Ins Co 20699 . Arctic Slope Regional Corporation INSURER C : 3900 C Street, Suite 201 INSURER D : Anchorage, AK 99503 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: SEA-003545480-06 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. I R TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXF; LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS LT R X COMMERCIAL GENERAL LIABILITY HDOG27629180 06/01/2018 06/01/2019 EACH OCCURRENCE $ 3,000,000 DAMAGETO CLAIMS-MADE ~ OCCUR PREMISES (Ea occur ence $ 100,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY Fx] JECOT F-1 LOC PRODUCTS - COMP/OP AGG $ 3,000,000 OTHER. $ A ISA H0886794A 06/01/2018 06101/2019 COMBINED SINGLE LIMIT $ 5,000,000 AUTOMOBILE LIABILITY Ea accident X ANY AUTO 'Hired Auto PD-ACV/Repair Cost' BODILY INJURY (Per person) $ OWNED L SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident Hired comp / colt ded. $ 1,000 X UMBRELLA LIAR X OCCUR X00 G28122676 003 06/01/2018 06101/2019 EACH OCCURRENCE $ 25,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 25,000,000 DED X RETENTION$50000 $ 2018 A WORKERS COMPENSATION WLR 048133149 (ADS) 06/0 06/01/ X STATUTE ORH 2 A AND EMPLOYERS' LIABILITY Y / N SCF 048133150 (WI) I) 06101/2018 0610112019 ANYPROPRIETOR/PARTNER/EXECUTIVE E L. EACH ACCIDENT 2,000,000 OFFICER/MEMBER EXCLUDED? ❑N N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 2,000,000 If yes, describe under 2,0~0,00~ DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Excess Work Comp/EL (AK) WCU 048133162 (AK) 06/0112018 06/0112019 Excess of $1,000,000 SIR Statutory Employers Liability 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) All Operations CERTIFICATE HOLDER CANCELLATION City of Ashland Service Center SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 90 N. Mountain Ave. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Ashland, OR 97520 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. David G. Wilkins ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 0002198 SP 0319 -C01-P02199-1 City of Ashland Service Center 90 N. Mountain Ave. Ashland, OR 97520