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HomeMy WebLinkAboutInsurance Certificate: American Industrial Door LLC AMERIND-03 APITTMAN ,dâ–ºCo/r°° CERTIFICATE OF LIABILITY INSURANCE DA 6/17/2019 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: Medford Office PayneWest Insurance,Inc. (A/c,No,Ext):(541)779-1321 FAX No):(541)779-9187 38 North Central Ave. ADDRESS: Medford,OR 97501 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Western National Assurance Company 24465 INSURED INSURER B:Western National Mutual Insurance Co 15377 American Industrial Door LLC;American Industrial Door Co. INSURER C: 5022 Table Rock Rd. INSURER D: Central Point,OR 97502 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD IMM/DD/YYYYI IMM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR CPP105950207 6/23/2019 6/23/2020 DAMAGES(RENTED 100,000 X PREMISES IEa occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2'000'000 POLICY X JE 9- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: Prop.Damage Ded $ 1,000 B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT a 1,000,000 (Ea accident) , $ X ANY AUTO CPP105847107 6/23/2019 6/23/2020 BODILY INJURY(Per person) $ X OWNED SCHEDULED AUTOS ONLY _ AUTOS BODILY INJURY(Per accident) $ AUTOS ONLY _ NON-OWNED ONLYY PROPERTY DAMAGE (Per accident) B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE _ $ 2,000,000 EXCESS LIAB CLAIMS-MADE UMB100969307 6/23/2019 6/23/2020 AGGREGATE $ 2,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER OMFFICROPRIE BOER EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ ( andatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 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) RE: 2013 Slurry Seal Project#2013-10 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ty ACCORDANCE WITH THE POLICY PROVISIONS. 20 E.Main St. Ashland,OR 97520 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD