HomeMy WebLinkAboutInsurance Certificate: S & S Sheetmetal Inc (2) ACCORD CERTIFICATE OF LIABILITY INSURANCE DATE 02/031 D/YYYY)
2/o3t2o,s
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
NAME: CLIENT CONTACT CENTER
FEDERATED MUTUAL INSURANCE COMPANY PHONE
HOME OFFICE: P.O. BOX 328 (A/c,No,Ext):888-333-4949 FAX No):507-446-4664
OWATONNA, MN 55060 ADDRESS:CLIENTCONTACTCENTER(a..FEDINS.COM
INSURER(S)AFFORDING COVERAGE NAIC#
INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935
INSURED 343-547-6 INSURER B:
S &S SHEETMETAL INC INSURER C:
912 ANTELOPE RD
WHITE CITY,OR 97503-1607 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:275 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.
INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
LTR INSR WVD IMMIDDIYYYY) (MMIDDIYYYY)
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000
DAMAGE TO RENTED
CLAIMS-MADE X OCCUR PREMISES Ea occurrence) $100'000
MED EXP(My one person) EXCLUDED
A N N 9910853 04/24/2018 04/24/2019 PERSONAL&ADV INJURY $1,000,000
GE_N'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
PRO X POLICY LOC $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 N N 9910853 04/24/2018 04/24/2019 BODILY INJURY(Per accident)
HIRED AUTOS ONLY NON-OWNED PROPERTY DAMAGE
_AUTOS ONLY (Per accident)
X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $2,000,000
A EXCESS LIAB CLAIMS-MADE N N 9910854 04/24/2018 04/24/2019 AGGREGATE $2,000,000
DED RETENTION
WORKERS COMPENSATION PER STATUTE OTH-
ER
AND EMPLOYERS'LIABILITY Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT
OFFICERIMEMBER EXCLUDED? N I A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE
If yes,describe under
E.L DISEASE-POLICY LIMIT
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space is required)
PROJECT LOCATION
ASHLAND FIRE STATION 111
455 SISKIYOU BLVD
ASHLAND OR, 97520
CERTIFICATE HOLDER CANCELLATION
343-547-6 275 0
CITY OF ASHLAND- PUBLIC WORKS DEPT 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 POUCY PROVISIONS.
AUTHORIZED REPRESENTATIVE ,,�
) , „
O 1988-2015 ACORD CORPORATION.All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
1