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HomeMy WebLinkAboutInsurance Certificate: S&S Sheetmetal Inc. (2) S&SSHEE-01 CBETTIN ,a►~Rl~ CERTIFICATE OF LIABILITY INSURANCE DATE (MM/YY) 019 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 Carol Bettin Anchor Insurance & Surety, Inc. PHHC°,NN, Ext ; (503) 224-2500 FAAC, No):(503) 224-9830 1201 SW 12th Ave. Suite 500 Portland, OR 97205 E-MAIL . cbeftin@anchorias.com INSURERS AFFORDING COVERAGE NAIC # INSURER A : SAIF Cor oration 36196 INSURED INSURER B : S & S Sheetmetal Inc. INSURER C 912 Antelope Road INSURER D White City, OR 97503 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 COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE ❑ OCCUR DAMAGE TO RENTED $ MED EXP An one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY u PRO- ❑ LOC PRODUCTS - COMP/OP AGG $ OTHER JECT : $ COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY ANY AUTO BODILY INJURY Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident $ HIRED NON-STED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ ER A WORKERS COMPENSATION X PER OTH- AND EMPLOYERS' LIABILITY 811929 10/1/2019 10/1/2020 STATUTE I 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y~ E.L. EACH ACCIDENT $ OFFICER/IVEMBER anila EXCLUDED? N/A (M (Mandatory ory in in NH) H) E.L. DISEASE - EA EMPLOYEE $ 11000,000 If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) City of Ashland HVAC 90 N. Mountain Ave., Ashland, OR 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 Y ACCORDANCE WITH THE POLICY PROVISIONS. 90 N. Mountain Ave. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE :oa ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD www.saif.com work. ~y %ai Life. Oregon. Carrier no: 20001 Endorsement no: WC000313 SAIF policy: 811929 S & S Sheetmetal, Inc. Waiver of Our Right to Recover from Others Endorsement We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Description: ALL OPERATIONS Contractor name: Persons and/or organizations with whom the insured-employer is required by written contract to waive subrogation rights. This endorsement does not alter the rights of an injured worker to pursue recovery from another party or SAIF to receive a statutory share of recoveries by an injured worker, even from the party listed in the schedule. The premium charge for this endorsement is based on one (1) percent of your manual premium. Effective date: October 01, 2019 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. Countersigned September 30, 2019 at Salem, Oregon Kerry Barnett President and Chief Executive Officer 400 High Street SE Salem, OR 97312 P: 800.285.8525 F: 503.373.8020 Pal PC7 E430B