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HomeMy WebLinkAboutInsurance Certificate: Altec Industries, Inc A ® DATE (MMIDDNYYY) CERTIFICATE OF LIABILITY INSURANCE 05/23/23/2012018 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, ANDTHE 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 C ONTACT Brldgette Taul NAME: MCGRIFF, SEIBELS & WILLIAMS, INC. (PHONE 800-476-2211 FAX P.O. BOX 10265 A/C No Ext; A/C No: - Birmingham, AL 35202 E-MAIL ADDRESS: btaul@mcgriN.com INSURER(S) AFFORDING COVERAGE NAIC0 INSURER A:Lexin ton Insurance Company 19437 INSURED INSURER a Hartford Fire Insurance Company 19682 Altec Industries, Inc. 1450 N 1 st. Street INSURER C :AIG Specialty Insurance Company 26883 Dixon, CA 95620 INSURER D:Trumbull Insurance Company 27120 INSURER E:Harlford Casual Insurance Company 29424 INSURER F : COVERAGES CERTIFICATE NUMBER:C7YW8A7J REVISION NUMBER: 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 rypE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR 0 WVO POLICY NUMBER MMIODMYY MM/DDtYYYY A• X COMMERCIAL GENERAL LIABILITY 013136094 06/01/2018 06/01/2019 EACH OCCURRENCE 8 5,000,000 N 3,000,000 CLAIMS-MADE X OCCUR PREMISES Eaoccurrence) 8 MED EXP (Anyone person) 8 N/A X PERSONAL & ADV INJURY It 5,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 8 10,000,000 POLICY PRO LOC - PRODUCTS - COMPIOPAGG 8 10,000,000, X " JECT OTHER: 8 B AUTOMOBILE LIABILITY 21CSES27903' 06101/2018 -0610112019 COMBINED SINGLE LIMIT _ 2,000,000 _ Ea accitlent E X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) 8 AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE "8 AUTOS ONLY AUTOS ONLY Per accident 8 s C X UMBRELLA LIAR X OCCUR BE28189531 06/01/2018 06/01/2019 EACH OCCURRENCE 5 10,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE 8 10,000,000 DED RETENTIONS 8 TH. D WORKERS COMPENSATION 21WNS27900(ADS) 06101/2018 0610112019 X PER TE OER -TH E AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE Y/N 21XWES27902(AL,MO,NC) E.L. EACH ACCIDENT 8 1,000,000 OFFICERIMEMBER EXCLUDED? NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 II G. describe under 1,000,000 DE SCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 8 5 5 8 5 8 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more apace is required) The City of Ashland, Oregon, its officers, agents and employees are additional insured under General Liability and Automobile Liability on a primary and non-contributory basis as required by written contract. See cancellation endorsement form attached. I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 0 Of Ashland AUTHORIZED REPRESENTATIVE 2 20 East Main Street Ashland, OR 97520 041 Page 1 of 4 @ 1988-2015 ACORD CORPORATION. All rights reserved. Arnon nc ronacmat 716,. Annon t,..... ..........:..a.....d -1 Arnon Altec, Inc. Policy No. 21CSES27903 k" U-y A THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S) This policy is subject to the following additional on file with the agent of record will be sufficient Conditions: proof of notice. If this policy is cancelled by the Company, other Any notification rights provided by this than for nonpayment of premium, notice of such endorsement apply only to active certificate cancellation will be provided to the certificate holder(s) who were issued a certificate of holder(s) with mailing addresses on file with the insurance applicable to this policy's term. agent of record. Such notice will be provided Failure to provide such notice to the certificate within 30 days of the Company's receipt of holder(s) will not amend or extend the date the certificate holder(s) information from the agent of cancellation becomes effective, nor will it negate record. cancellation of the policy. Failure to send notice If notice is mailed, proof of mailing to the last shall impose no liability of any kind upon the known mailing address of the certificate holder(s) Company or its agents or representatives. Form IH 0310 06 11 Page 1 of 1 © 2011, The Hartford ENDORSEMENT # 038 Forms a part of policy no.: 013136094 issued to: ALTEC, INC. ATTN: MARK BERTOVIC By: LEXINGTON INSURANCE COMPANY ADVICE OF CANCELLATION TO ENTITIES OTHER THAN THE NAMED INSURED LIMITED TO E-MAIL NOTIFICATION This policy is amended as follows: In the event that the Insurer cancels this policy for any reason other than non payment of premium, and 1, The cancellation effective date is prior to this policy's expiration date; 2. The First Named Insured is under an existing contractual obligation to notify a certificate holder when this policy is canceled (hereinafter, the "Certificate Holder(s)"); and-has provided to the Insurer, either directly or through its broker of record, the email address of the contact at such entity, and the Insurer received this information after the First Named Insured receives notice of cancellation of this policy and prior to this policy's cancellation effective date, via an electronic spreadsheet that is acceptable to the insurer, the Insurer will provide advice of cancellation (the 'Advice') via e-mail to such Certificate Holders. Proof of the Insurer emailing the Advice, using the Information provided by the First Named Insured, will serve as proof that the Insurer has fully satisfied its obligations under this endorsement. This endorsement does not affect, in any way, coverage provided under this policy or the cancellation of this policy or the effective date thereof, nor shall this endorsement invest any rights in any entity not Insured under this policy. The following Definitions apply to this endorsement: 1. First Named Insured means the Named Insured shown on the Declarations Page of this policy. 2. Insurer means the insurance company shown in the header on the Declarations Page of this policy. All other terms and conditions remain unchanged. I Authorized Representative OR Countersignature (in states where applicable) LEXD00021 LX0404 Altec, Inc. Policy No. 21WNS27900 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S) This policy is subject to the following additional on file with the agent of record will be sufficient Conditions: proof of notice. If this policy is cancelled by the Company, other Any notification rights provided by this than for nonpayment of premium, notice of such endorsement apply only to active certificate cancellation will be provided to the certificate holder(s) who were issued a certificate of holder(s) with mailing addresses on file with the insurance applicable to this policy's term. agent of record. Such notice will be provided Failure to provide such notice to the certificate within 30 days of the Company's receipt of holder(s) will not amend or extend the date the certificate holder(s) information from the agent of cancellation becomes effective, nor will it negate record. cancellation of the policy. Failure to send notice If notice is mailed, proof of mailing to the last shall impose no liability of any kind upon the known mailing address of the certificate holder(s) Company or its agents or representatives. Form IH 03 10 06 11 Page 1 of 1 © 2011, The Hartford i