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HomeMy WebLinkAboutInsurance Certificate: Springsted Waters 0 DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 8/2/2018 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 Phone: (952)944-2929 CONTACT Jane Doerfler Fax: (952)944-3091 NAME - - Horizon Agency, Inc. a~No Ext : (952)914-7131 _ A/C No): E-MAIL 6500 City West Pkwy # 100 jane(cihor zonagency.com - MAIL SS_ Eden Prairie, Minnesota 55344 INSURER(S) AFFORDING COVERAGE NAIC If INSURER A : Federal Insurance Company li 20281 INSURED INSURER B : Executive Risk Indemnity Inc. 351 81 Springsted I Waters INSURER C : 380 Jackson Street #300 INSURER D : St. Paul, MN 55101 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 10006 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 ADDL,SUBR POLICY EFF I POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD V POLICY NUMBER MM/DD/YYYY MM/DD/YYYY 1 ✓ COMMERCIAL GENERAL LIABILITY X135342568 ~8/I1/2018 18/11/2019 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 000 A CLAIMS-MADE ✓ OCCUR $0 Deductible PREMISES (Ea occurrence) _ $ 1,10,000 i MED EXP (Any one person) $ PERSONAL & ADV INJURY ! $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL GATE ! $ 2'000'000 ✓ POLICY PRO JECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY 73234006 8/1 1/2018 8/11/2019 COMBINED SINGLE LIMIT $ 1,000,000 A L 1 1 (Ea accident) ANY AUTO BODILY INJURY (Per person) $ H OWNED SCHEDULED ✓ BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS PROPERTY DAMAGE 1 $ ✓ HIRED ✓ NON-OWNED AUTOS ONLY AUTOS ONLY (Per accidence $ ( I ✓ UMBRELLA LIAB ✓ OCCUR 79764838 118/11/2018 118/11/2019 EACHOCCURRE_NCE $ 2,000,000 A EXCESS LIAB CLAIMS-MADE li AGGREGATE $ 2+~~~+~~~ DED ✓ RETENTION $ WORKERS COMPENSATION 71646620 8/11/2018 8/11/2019 ✓ 1 STATUTE ORTH- A AND EMPLOYERS' LIABILITY - ANYPROPRIETOR/PARTNER/EXECUTIVE Y / N ! E.L. EACH ACCIDENT $ 500100n OFFICER/MEMBER EXCLUDED? ❑N IN /A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 500,00 If yes, describe under 500,00(I I DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ B Errors & Omissions 82079210 1/14/2018 1/14/2019 Ea°I'claim 2,000,0O('; $25,000 Deductible AeKr~~~« 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Ashland, Oregon, and its elected officials, officers and employees are included as Additional insureds but only with respect to Consultant's services to be provided under this agreement. Insurance is primary and non-contributory CERTIFICATE HOLDER CANCELLATION Holder's Naive of Interest : Additional Insured SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main Street Ashland, OR 97520 AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD