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HomeMy WebLinkAboutInsurance Certificate: Olsson Industrial Electric, Inc. ACC5 DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 05/08/2019 �� 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 1301 5th Avenue,Suite 1900 1A/C.No.Extl: (e/C.No): Seattle,WA 98101 E-MAIL ' Attn:seattle.certrequest@marsh.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# CN101923908-NAES-GAWU-19-20 INSURER A:Zurich American Insurance Company 16535 INSURED INSURER B:American Zurich Insurance CO. 40142 Olsson Industrial Electric,Inc. 1180 NW Maple Street,Suite 200 INSURER c:ACE Property And Casualty Ins Co 20699 _ Issaquah,WA 98027 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: SEA-003489452-27 REVISION NUMBER: 2 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 1NSD WVD (MM/DD/YYYY) (MM/DD/YYYY) , A X COMMERCIAL GENERAL LIABILITY GL05574116-06 05/20/2019 05/20/2020 EACH OCCURRENCE $ 2,000,000 DAMAGE TO CLAIMS-MADE X OCCUR PREMISES EaEoccur ence ) $ 1,000,000 X SIR$200,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE s 4,000,000 POLICY PRO LOC PRODUCTS-COMP/OP AGG $ 4,000,000 X PRO- OTHER: $ A AUTOMOBILE LIABILITY BAP9830191-09 05/20/2019 05/20/2020 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AU TO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) COMP/COLL DED $ 5,000 C X UMBRELLA LIAB X OCCUR X00 G27833238005 05/20/2019 05/20/2020 EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED X RETENTION$1,000,000 $ B WORKERS COMPENSATION WC5574117-06(AOS) 05/20/2019 05/20/2020 X PER I OTH- AND EMPLOYERS'LIABILITY STATUTE ER B ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N WC5574118-06(WI) 05/20/2019 05/20/2020 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 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City of Ashland,Oregon and its elected officials,officers and employees are included as additional insured where required by written contract and allowed by law with respect to General Liability,Automobile Liability,and Umbrella Liability. This insurance shall be primary and non-contributory and limited to liability arising out of the operations of the named insured when required by written contract. CERTIFICATE HOLDER CANCELLATION 1 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. Greg Miller At e' Iy , 4, ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD