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HomeMy WebLinkAboutInsurance Certifcate: RW Hays CO. Faxmodem2 • (2/4) 06/21/2019 11 : 00:00 AM -0700 • Rd DATE(�DINYYTY) CERTIFICATE OF LIABILITY INSURANCE 06/21/2019 THIS CERTIFICATE IS ISSUED ASA 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 pollcy(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 Pam Wimmer NAME: Elliott Powell Baden and Baker Inc. rPHON u (503)227-1771 I FAX No): (503)274-7644 An ISU Network Member ADDRESS: pwimmer@epbb.com 1521 SW Salmon Street INSURER(S)AFFORDING COVERAGE NAIC N Portland OR 9 720 5-1 783 NBURERA: United States Flre Insurance Co. 211113 INSURED IICURER B: Certain Underwriters at Lloyds AA1122000 RW Hays Co. 'muffs C: Endurance American Specialty Ins Co 41718 DBA:Hays 011 Company - SOURER D: PO Box 1220 INSURER E: Medford OR 97501 INSURER F: COVERAGES CERTIFICATE NUMBER: 19-20 GL/AUTO/MTC/XS REVISION NUMBER: THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDINGANY 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. rise AOULnuUN POLICY kW POLICY EXP • LTR TYPE OF INSURANCE RPM WVp POLICY NUMBER (MM,DDANYY) (MWDDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY I 1,000,000 EACH OCCURRENCE UAMAGETORhNItD 100,000 CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one parson) $ Excluded EX A Y 5066967211 07/01/2019 07/01/202(1 PERSONAL Saov INJURY $ 1,000,000 GSM AGGREGATE LIMIT APPLIES PER: • GENERALAGGREGATE $ 2,000,000 X POLICY n jEOT El LOC • • PRODUCE-COMP/OPAGG $ 2,000,000 OTHER: Employee Benefits AUTOMOBILE LIABILITY COMBINED SINGLE UNIT $ 1,000,000 (Ea=Man) X ANY AUTO BODILY INJURY(Per person) $ A OWNED lli SCHEDULES 5068967211 07/D1/2019 07/01/2020 BODILY INJURY(Per sudden) $ AUTOS ONLY IlllI NON-OWNED HIRED AUTOS PROPERTY cdenfl MADE X AUTOS ONLY AUTOS ONLY (Pere MOWS Uninsured motorist $ 1,000,000 UMBRELLA UAD EACI-t CCURR `E"'• 5,000,000 X OCCUR EACH OCCURRENCE $ B X EXCESS LIAR CLAIMS-MADE 18RENMA180005510157901 07/01/2019 07/01/2020 AGGREGATE $ 5,000,000 DED I RETENTION$ - $ WORKERS COMPENSATION I STATUTE I I ATM AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N)A EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? Mandatory In NH) ) EL DISEASE-EA EMPLOYEE $ II yes,describe under DESCRIPTION OF OPERATIONSbel0W EL DISEASE-POUCYUMIT $ $5,000000 Occurrence $5a00,000 AN C/A Excess Liability Property of Others In Thank EXC30000382501/5088987211 07/01/2019 07/01/2020 In Transit $50,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,AddNonal Remarks Schedule,may be attached N mom space la required) Re:Delivery of Fuel. CG 20 26 04 13 Is attached. • CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELWERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 90 N Mountain Ave AUTHORIZED REPRESENTATIVE Ashland OR 97520 • ®1988-2015•ACORD CORPORATION. All rights reserved. ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD • • faxmodem2 ( 3/4) 06/21/2019 11 : 01 : 07 AM -0700 • POLICY NUMBER 5068967211 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE r Name Of Additional Insured Person(s) Or Organlzation(s): ANY PERSON OR ORGANIZATION THAT THE INSURED HAS AGREED BY WRITTEN CONTRACT OR WRITTEN AGREEMENT TO NAME AS AN ADDITIONAL INSURED AND EXECUTED PRIOR TO THE OCCURRENCE OF ANY LOSS. Information required to complete this Schedule, If not shown above,will be shown In the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the Insurance afforded to these Include as an additional Insured the person(s) or additional Insureds, the following Is added to organization(s) shown In the Schedule, but only Section III —Lints Of Insurance: with respect to liability for"bodily injury", 'property If coverage provided to the additional Insured Is damage" or 'personal and advertising injury" required by a contract or agreement, the most we caused, In whole or in part, by your acts or will pay on behalf of the additional Insured is the omissions or the acts or omissions of those acting amount of insurance: on your behalf: 1. In the performance of your ongoing 1. Required by the contract or agreement; or operations; or 2. Available under the applicable Limits of 2. In connection with your premises owned by or Insurance shown In the Declarations; rented to you. whichever Is less. However: This endorsement shall not increase the 1. The Insurance afforded to such additional applicable Limits of Insurance shown in the Insured only applies to the extent permitted by Declarations. law; and 2. If coverage provided to the additional Insured is required by a contract or agreement, the Insurance afforded to such additional Insured will not be broader than that which you are required by the contract or agreement to provide for such additional Insured. CG 20 26 0413 ©insurance Services Office, Inc., 2012 Page 1 of 1 faxmodem2 (4/4) 06/21/2019 11 : 02:23 AM -0700 . Page 1 of 1 ROr CERTIFICATE OF LIABILITY INSURANCE DATE( M10DNYTh 02/01/2019 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 pollcy(les)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 endorseement(e). PRODUCER CONTACT NAME Willie of Greater Kansas, Inc. PRONE 1-977-915-7378 FAX No : 1-Bab-467-2378 c/o 26 Century Blvd B.O. Box 305191 ADDRESS: certifioates9riTlis.ccm Naebville, TM 372309191 USA • INSURER(S)AFFORDING COVERAGE NAM 0 INSURER A: ACE American Insurance Company 22667 INSURED I INSURER B: • Barrett essiees. Service*, Inc. 8100 NS Parkway Drives INSURER C: Smite 200 1 INSURER D: Vancouver, BA 98662 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:W10033931 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 ADDL SUER POLICY EFF POLICY EXP LTII INSD WWD POLICYNUMBEB (MMIDWYYYY1 MIPMEI/YYYYI UNITE COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE n OCCUR, DAMAGE PREMISES( o SES(En oon rren®1 $ I MED D(P(Anyone person) • $ PERSONAL&ADV INJURY S • GEN.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1 POLICY n jEla 7 LOC PRODUCTS-COMP/OP AGO $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY Par person) $ OWNED SCHEDULED BODILY INJURY er $ AUTOS ONLY AUTOS I (P accident) HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY , (Per accident) $ UMBRELLA LIAR 1 OCCUR EACH OCCURRENCE _ $ EXCESS LUIS CLAIMS-MADE AGGREGATE $ DED RETENTIONS $ WORKERS COMPENSATION . X I STATUTE I I EAµ AND EMPLOYERS'LIABILITY A ANYPROPRIETOR/PARmER,FJ(CCLTTNE YIN EL EACH ACCIDENT $ 2,000,000 OFFICER/MEMBER EXCLUDED? NM NCO C65439030 02/01/2019 07/01/2020 (Mandatory In coq EL.DISEASE-EA EMPLOYEE $ 2,000,000 If yes,describe under 2,000,000 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMB' 5 i ■ DESCRIPTION OF OPERATIONS/LOCATIONS/BOUCLES(ACORD 101,AddDiond Remarks Schedub,na y be attached If mere space Is rebuked) Staten covered: AZ, UT, NV, OR, WA Limits shown are above a 85,000,000 Self Insured Retention 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. AUTHOREED REPRESENTATIVE Proof of Coverage •V� 14.4.C. ACORD 26(2016/03) The ACORD name and logo are ®1988-2016 ACORD CORPORATION, All rights reserved. og registered marks of ACORD 6A on 17482316 MINI: 1053057 xmodem2 ( 1/4) 06/21/2019 10 : 59 : 37 AM -0700 This is a fax from epb&b insurance Elliott; Powell,Bedell&IlaLer,lair, 1521 SW Salmon St. Portland, OR 97205 503-227-1771 503-274-7644 (main fax) Date: 06/21/2019 10:58:44 AM # of pages: 3 Fax#: 15414885320 Email: kwykes @epbb.com Subject: RW Hays Co • • Comments: Kim Wykes Commercial Lines Account Manager ELLIOTT, POWELL, BADEN & BAKER, INC. P:503-445-8441 I F: 503-445-8481 I kwykes @epbb.com<mailto:kwykes @epbb.com> Online payments<http://epbb.com/index.php/2012-08-29-22-44-42/make-a=payment> I Secure file system<https://securemail.epbb.com/filedrop/kwykes @epbb.com> I Google reviews<https://search.google.com/local/writereview?placeid=ChIJD16yZhwKIVQRYsOMQQ4sbls> Customer feedback<http://epbb.com/index.php/contact-us2/tell-us-how-we-re-doing/view/form> [epbb logo]<http://www.epbb.com/> This communication, including any attachments, is intended for the sole and exclusive use of the addressee and may contain proprietary, confidential, and/or privileged information. If you are not the intended recipient, any use,copying, disclosure, dissemination, or distribution of the information is strictly prohibited. •