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HomeMy WebLinkAboutInsurance Certificate: Welburn Electric l ® DATE(MM/DD/YYYY) AC O CERTIFICATE OF LIABILITY INSURANCE 12/10/2018 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 CONTACT Protectors Insurance, LLC PHONE Terry Friend FAX P.O. Box 4669 (NC.No.Ext):541-842-2958 (A/C,No):541-772-1906 Medford OR 97504 ADDRESS: terryf @protectorsins.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:The Cincinnati Insurance Co 10677 INSURED WELBU-1 INSURER B:SAIF Corporation 524113 Welburn Electric Inc PO Box 329 INSURER C: Phoenix OR 97535 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:19145849 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EPP 0295267 12/23/2018 12/23/2019 EACH OCCURRENCE $1,000,000 DAMAGE TO CLAIMS-MADE X OCCUR PREMISES(EaEoccurrence) $1,000,000 MED EXP(Any one person) $15,000 PERSONAL 8 ADV INJURY $1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY EBA 0295267 12/23/2018 12/23/2019 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) A UMBRELLA LIAB OCCUR EPP 0295267 12/23/2018 12/23/2019 EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION 488390 10/1/2018 10/1/2019 'MUTE OTH AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLU DED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) As additional insured per policy endorsement GA233. 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. City of Ashland 20 E Main St 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 Coverage Summary CGL Contractors' Broadened Endorsement Contractors' Commercial General Liability Broadened Endorsement GA233 Liability Coverages Limits Employee benefit liability ($1,000 deductible) $1,000,000 each employee/ $3,000,000 aggregate Expands damage to premises rented to insured to include lightning, At the lesser of$500,000 or the smoke, soot or water CGL each occurrence limit Waiver of subrogation if required in a written contract Included Unintentional failure to disclose existing hazards provision Included Broadened notice of occurrence Included Property damage to borrowed equipment when not in use $10,000 each occurrence ($250 deductible) Newly formed or newly acquired organizations for up to 180 days Included Automatic additional insured coverage where required in a written contract or oral agreement (where a certificate of insurance showing that person or organization as an additional insured has been issued) Included for: lessors of premises, lessors of equipment, vendors, state or political subdivision's permits relating to premises, state or political subdivision's permits relating to contractor operations Automatic additional insured coverage where required in a written contract or oral agreement (where a certificate of insurance showing that person or organization as an additional insured has been issued) from Included the named insured's work performed for that person or organization. Varying degrees of coverage apply based upon the additional insured requirements included in written and oral contracts (except AZ) Supplementary payments • Bail bonds $1,000 • Loss of earnings $350 per day Employees as insureds for specified healthcare services (nurses, EMTs Included and paramedics) Medical payments $10,000 any one person Voluntary property damage ($250 deductible) $1,000 each occurrence Care, custody or control ($250 deductible) $5,000 each occurrence Broadened contractual liability for work within 50 feet of railroad property Included This is not a policy.For a complete statement of the coverages and exclusions,please see the policy contract.For information,coverage availability in your state.quotes or policy service.please contact your local independent agent recommending coverage."The Cincinnati Insurance Companies"and"Cincinnati"refer to member companies of the insurer group providing property and casualty coverages through 0 The Cincinnati Insurance Company or one of its wholly owned subsidiaries—0 The Cincinnati Indemnity Company.0 The Cincinnati Casualty Company or0 The Cincinnati Specialty Underwriters Insurance Company—and life and disability income insurance and annuities through 0 The Cincinnati Life Insurance Company.Each insurer has sole financial responsibility for its own products.Not all subsidiaries operate in all states.6200 S.Gilmore Road,Fairfield,OH 45014-5141.wvrwcinfin.com ��� ---- TM[ Copyright O 2012 The Cincinnati Insurance Company.All rights reserved.Do not post online,in whole or in part, CINCI N NATI without written permission. f • INSURANCE COMPANIES sOr Ariv GC3d(7/19) Fr{?