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HomeMy WebLinkAboutInsurance Certificate: Pape Machinery Inc A��® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 03/04/2019 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 111 SW COLUMBIA,STE.500 (A/C.No.Extl: (A/C,No): PORTLAND,OR 97201 E-MAIL Attn:Amy Shafer 503-248-4857;amy.shafer @marsh.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# CN101920225-STND-GAWU-19-20 PMACH INSURER A:National Union Fire Insurance Company 19445 INSURED INSURER B:N/A N/A PAPE'MACHINERY,INC. C/O THE PAPE'GROUP INSURER C:N/A N/A PO BOX 407 INSURER D:N/A N/A EUGENE,OR 97440 INSURER E:N/A N/A INSURER F:Navigators Insurance Company 42307 COVERAGES CERTIFICATE NUMBER: SEA-003202239-65 REVISION NUMBER: 3 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 SWVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY GL 5180113 03/01/2019 03/01/2020 EACH OCCURRENCE $ 2,000,000 AMAGE G CLAIMS-MADE X OCCUR XSC30000974300 03/01/2019 03/01/2020 PREM SESO(Ea occur ence) $ 250,000 X CONTRACTUAL LIAB MED EXP(Any one person) _ $ 25,000 X PER PROJECT AGG$2M PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY X E X LOC PRODUCTS-COMP/OP AGG $ 4.000,000 OTHER: $ A AUTOMOBILE UABILITY CA 2961543 03/01/2019 03/01/2020 COMBINED SINGLE LIMIT $ 5,000,000 (Ea accident) F X ANY AUTO NY19FXR837953IV 03/01/2019 03/01/2020 BODILY INJURY(Per person) $ G X OWNED SCHEDULED XSC30000974100 03/01/2019 03/01/2020 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: THE CITY OF ASHLAND,OREGON,AND ITS ELECTED OFFICIALS,OFFICERS AND EMPLOYEES ARE INCLUDED AS ADDITIONAL INSUREDS WHEN REQUIRED BY WRITTEN AGREEMENT OR CONTRACT AS RESPECTS TO OPERATIONS OF THE NAMED INSURED. CERTIFICATE HOLDER CANCELLATION CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 EAST MAIN STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ASHLAND,OR 97520 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Raymond M.Schneider , ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: ON 101920225 LOC#: Portland AFRO ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED MARSH USA INC. PAPE'MACHINERY,INC. C/O THE PAPE'GROUP POLICY NUMBER PO BOX 407 EUGENE,OR 97440 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance INSURERS AFFORDING COVERAGE/NAIC# INSURER G: Endurance American Insurance Company (10641) Workers'Compensation(continued): Policy#483762(OR) Insurer:SAIF Effective Date: 01/01/2019 Expiration Date:01/01/2020 Workers'Compensation:Statutory Limits Employer's Liabiility:$1,000,000 Each Accident/$1,000,000 Disease-Each Employee/$1,000,000 Disease-Policy Limit ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD