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HomeMy WebLinkAboutInsurance Certificate: Rogue Waste Systems LLC Client#: 1137013 ROGUEWAS ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)9/24/2018 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Teresa Weston i NAOME: USI Insurance Services NW PHONE 541 685-5300 FAX (A/C,No,Ext): (A/C,No): _ 975 Oak Street,Suite 900 ADDRESS: teresa.weston @usi.com Eugene,OR 97401 541 685-5300 INSURER(S)AFFORDING COVERAGE NAIL# INSURER A:Greenwich Insurance Company 22322 INSURED INSURER 13:XL Specialty Insurance Company 37885 Rogue Waste Systems LLC -- INSURER C:SAIF Corporation 36196 One West Main St.,Suite 401 -- Medford,OR 97501 INSURERD: 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. L RR TYPE OF INSURANCE INSR WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MOLIC YEFF (POLIC YYYY) A X COMMERCIAL GENERAL LIABILITY GEC003582707 10/01/2018 10/01/2019 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR PREMISES ERENTED nce) $100,000 X BI/PD Ded:$1,000 MEDEXP(Anyoneperson) $5,000 PERSONAL&ADV INJURY $1,000,000_ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- POLICY PRODUCTS $2,000,000 JECT I II LOC OTHER: $ A AUTOMOBILE LIABILITY AEC003582407 10/01/2018 10/01/2019 (Ea COMBIaccidenNED t)SINGLE LIMIT I$1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED AUTOS ONLY SCHEDULED AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ B X UMBRELLALIAB X OCCUR UEC003582507 10/01/2018 10/01/2019 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 DED X RETENTION$$10,000 $ C WORKERS COMPENSATION 519473 10/01/2018 10/01/2019 MUTE EMPLOYERS'LIABILITY STATUTE ER ANY OFFICER/MEMBER EXCLUDwD?ECUTIVEYN N/A fA E.L.EACH ACCIDENT $1,000,000 (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 I 1 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 listed as additional insureds but only with respects to the services provided by Rogue Shred, LLC. CERTIFICATE HOLDER CANCELLATION Cit of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 East Main St. ACCORDANCE WITH THE POLICY PROVISIONS. Ashland,OR 97502-0000 AUTHORIZED REPRESENTATIVE (.E -, S. rte.,ut' ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S23909492/M23892729 NSNZP Client#: 1137013 ROGUEWAS ACORDT, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYI)9/24/2018 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. 1 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Teresa Weston USI Insurance Services NW PHONE 541 685-5300 FAX (A/C,No,Ext): (A/C,No): 975 Oak Street,Suite 900 ADDRESS: teresa.weston @usi.com Eugene,OR 97401 INSURER(S)AFFORDING COVERAGE NAIC# 541 685-5300 Greenwich Insurance Company 22322 ' INSURER A INSURED INSURER B:XL Specialty Insurance Company 37885 Dry Creek Landfill, LLC INSURER C: One West Main St.,Suite 401 Medford,OR 97501 INSURER D: INSURERE: _ 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 EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY GEC003582707 10/01/2018 10/01/2019 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR PREMISES TO nce) $100,000 X BI/PD Ded:$1,000 MEDEXP(Anyoneperson) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- PRODUCTS-COMP/OP AGG $2 000 000 POLICY JECT LOC � � OTHER: $ A AUTOMOBILE LIABILITY AEC003582407 10/01/2018 10/01/2019 Ea aBciI j INGLE LIMIT $1,000,000 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) $ B X UMBRELLA LIAB X OCCUR UEC003582507 10/01/2018 10/01/2019 EACH OCCURRENCE $3,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $3,000,000 1 DED X RETENTION$$10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A — (Mandatory in NH) E.L.DISEASE-EA EM PLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below _ E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Ashland its officers,agents and employees are added as additional insureds. CERTIFICATE HOLDER CANCELLATION of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 E Main ACCORDANCE WITH THE POLICY PROVISIONS. Ashland,OR 97520-0000 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S23909549/M23892301 NSNZP