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HomeMy WebLinkAboutInsurance Certificate: Thatacher Company ACORD® AC DATE(MMIDD/YYYY) L....---- CERTIFICATE OF LIABILITY INSURANCE 3/27/2019 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 NAME: Carolyn Maldonado Arthur J. Gallagher Risk Management Services, Inc. PHONE FAX g01-290 3181 6967 South River Gate Drive,#200 (A/c.No,Ext): (A/C.No):801-924-1441 Salt Lake City UT 84047 ADDRESS: Carolyn Maldonado@ajg.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:AIG Specialty Insurance Company 26883 INSURED THATCOM-01 INSURER B:National Union Fire Insurance Company of Pittsburg 19445 Thatcher Company, Inc.Box INSURER C:New Hampshire Insurance Company 23841 P 0 Box 27407 p p y Salt Lake City UT 84127 INSURER D:Everest National Insurance Company 10120 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:333393596 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 SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE ,INSD WVD POLICY NUMBER IMM/DD/YYYYI IMM/DD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY V EG14246248-01 4/1/2019 4/1/2020 EACH OCCURRENCE $1,000,000 _ CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $300,000 MED EXP(Any one person) $25,000 PERSONAL&ADV INJURY $1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO POLICY X JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: POLLUTION LEGAL $1,000,000 B AUTOMOBILE LIABILITY Y CA4489610 4/1/2019 4/1/2020 COMBINED SINGLE LIMIT $1000000 , , (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 UMBRELLALIAB X OCCUR EGU14246249-01 4/1/2019 4/1/2020 EACH OCCURRENCE $6,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $6,000,000 DED RETENTION$ $ C WORKERS COMPENSATION WC015893603 4/1/2019 4/1/2020 X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N/A - (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 D Motor Truck Cargo IM8CM00012-191 4/1/2019 4/1/2020 Cargo $100,000 A Pollution Liability EG14246248-01 4/1/2019 4/1/2020 Limit $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Verification of insurance subject to the terms and conditions of the policy Named Insured's: Thatcher Company,In Inc. CITY RECORD: Thatcher Group,Inc. Thatcher Transportation,Inc. I I Thatcher Company of Arizona,Inc. Thatcher Company of California,Inc. Thatcher Company of Montana,Inc. See Attached... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 90 N. Mountain Ashland OR 97520 AUTHORIZED REPRESENTATIVE USA ,:44°5 1 /f ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: T_HATCOM-01 _ LOC#: ACCPRO ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Arthur J.Gallagher Risk Management Services,Inc. Thatcher Company,Inc. P 0 Box 27407 POLICY NUMBER Salt Lake City UT 84127 • CARRIER NAIC CODE 1 EFFECTVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Thatcher Company of Nevada,Inc. Thatcher Company of New York,Inc. Thatcher Chemical of Florida,Inc. Thatcher Pharmaceuticals,Inc. Thatcher Company of North Dakota,Inc. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ENDORSEMENT NO. 11 This endorsement, effective 12:01 Af6i, 04/01/2019 Forms a part of Policy No.: EG14246248-01 ' Issued to: THATCHER COMPANY By: AIG SPECIALTY INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LIMITED ADVICE OF CANCELLATION TO ENTITIES OTHER THAN THE NAMED INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY AND POLLUTION LEGAL LIABILITY COVERAGE FORM It is hereby agreed that the following is added to SECTION IV- CONDITIONS: • In the event that we cancel this Policy for any reason other than non-payment of premium, and 1. the cancellation effective date is prior to this Policy's etpiration date; 2. you are under an existing contactual obligation to notify a certificate holder when this Policy is canceled thereinafter, the "Certificate Holders)") and have provided to us, either directly or through your broker of record,the email address of a contact at each such entity; and 3. we received this information after you received notice of cancellation of this Policy and prior to this Policy's cancellation effective date,via an electronic spreadsheet that is acceptable to us, we will provide advice of cancellation (the "Advice") via e-mail to each such Certificate Holders within 30 days after you provide such information to us. Proof of our emailing the Advice, using the information provided by you, will serve as proof that we have fully satisfied our 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. All other terms, conditions, and exclusions shall remain the same. UTHORIZED REPRESENTATIVE or countersignature (instates where applicable) 109821(9/11) PAGE 1 OF 1 C15040 • POLICY NUMBER: CA 448-96-10 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: 04/01/2019 Countersigned By: Named Insured: THATCHER COMPANY, INC. (Authorized Representative) SCHEDULE Name of Person(s)or Organization(s): AS REQUIRED PER WRITTEN CONTRACT CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 2 (If no entry appears above, information required to complete this endorsement will be shown in the Declara- tions as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualities as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. • • Page 2 of 2 Copyright, Insurance Services Office, Inc., 1998 CA 20 48 02 99 • • ENDORSEMENT NO. 13 This endorsement,effective 12:01 Atvi, ,04/01/2019 Forms a part of Policy No.: EG14246248-01 Issued to: THATCHER COMPANY By: AIG SPECIALTY INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. • COVERAGES A, B AND E ADDITIONAL INSURED - DESIGNATED PERSON(S) OR ORGANIZATION(S) ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY AND POLLUTION LEGAL LIABILITY COVERAGE FORM Solely as respects Coverages A, B and E, SECTION II - WHO IS AN INSURED is amended to include as an insured the person(s) or organization(s) shows in the Schedule below, but only with respect to bodily injury, property damage, personal and advertising injury, environmental damage or emergency response costs caused in whole • or in part by your acts or omissions or the acts or omissions of those acting on your behalf: A. In the performance of your work;or B. In connection with your premises owned by or rented to you. SCHEDULE Name of Additional Insured Person(s) or Organization(s): BLANKET WHERE REQUIRED BY WRITTEN CONTRACT OR WRITTEN AGREEMENT • All other terms, conditions, and exclusions shall remain the same. • UTHORIZED REPRESENTATIVE or countersignature (in states where applicable) 103366 (9111) PAGE 1 OF 1 C15034 Kariann Olson From: Eleni Stathis <mail-server @csr24.email> Sent: Wednesday, March 27, 2019 10:52 AM To: Kariann Olson Subject: 17-18 Thatcher Company of California, Inc. Certificate Attachments: CERT-333393596.pdf Hello, Please see the attached certificate. Please let me know if you need any revisions. Thanks, Eleni Broadwater Assistant Account Manager Gallagher Presidio 801.924.1441 Fax 800-924-1404 Toll Free 1