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HomeMy WebLinkAboutInsurance Certificate: Welburn Electic CERTIFICATE OF LIABILITY INSURANCE DATE (MM ODYYYY) 9/12/2019 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 NAME:OT Terry Fdend Protectors Insurance, LLC PHONE FAX P.O. Box 4669 Arc E111, 541-842-2958 ac No); 541-772-1906 Medford OR 97504 nMDAn' REss: to rolectorsins.com INSURERS AFFORDING COVERAGE NAICN INSURER A: The Cincinnati Insurance Co 18677 INSURED WELBU-1 INSURER B: SAIF Corporation 524113 Welburn Electric Inc PO Box 329 INSURERC: Phoenix OR 97535 INSURER D: IRERE: NNSUSURER F: COVERAGES CERTIFICATE NUMBER: 138437902 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 LIMITS INSR TYPE OF INSURANCE JUM $U D POLICYNUMBER MMILDDYfYYYY MMIDDY/YYYY R A X COMMERCIALGENERALLIABIUTY Y EPP 0295267 12/23/2018 1212312019 EACHOCCURRENCE $1,000,000 CLAIMS-MADE r-XI OCCUR PREMISES Ea occurrence $1,000,000 MED EXP (Any one person) $15,000 PERSONALS ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $2,000,000 X POLICY ff] JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY Y EBA 0295267 12/2312018 12/2312019 COMBINED SINGLE LIMIT $1,000,000 Ea ac6d.nt X ANYAUTO BODILY INJURY (Par person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Peraccidenl $ A X UMBRELLALIAB X OCCUR EPP 0295267 12/23/2018 12123/2019 EACH OCCURRENCE $5,000,000 EXCESS UAB CLAIMS-MADE AGGREGATE $5,000,000 DEG RETENTION$ $ 8 WORKERSCOMPENSATION 488390 1011/2019 1011/2020 AND EMPLOYERS' LIABILITY YIN STATUTE ER ANYPROPRIVOWPARTNERIEXECUTIVE ❑ N/A E.L. EACH ACCIDENT $1,000,000 OFFICERIMEM BER EXCLUDED (Mandatory In NH) E.L. DISEASE-EA EMPLOYEE $1,000,000 It yes, describe under DESCRIPTION OF OPERATIONS belm E.L. DISEASE - POLICY LIMIT $1,000,000 A Professional EPP 0295267 12/23/2018 12/2312020 1000000 500D deductible Pollution 1000000 3000 deductible DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) As additional insured per policy endorsement GA233. 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. City of Ashland 20 E Main St AUTHORIZEDREPRESENTATIVE Ashland OR 97520 4fnl ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Employees as insureds for specified healthcare services (nurses, EMTs Included ,and paramedics) Medical payments $10;000 any one person Voluntary property damage ($250 deductible) $1,000 each occurrence Care, custody or control ($250 deductible) $5;000 each occurrence Broadened contractual liability for work within 50,feet of railroad property Included This Is not a policy. Foi a complete statement of the, coverages and exclusions, please see the policy contract. For uformatlnn,covenegs; 'availability In your state, quotes or policy service; please contact your local Independent agent recommending covomge.'fhe Cincinnati insurance Companies' and ."Cincinnati referlo member-companles of the Insurer group providing property and c6sualty coverages through a The Cincinnati Insurance Company or one of Its wholly owed subsidiaries- a The Cincinnati Indemnity. Company, o The:Clnclnnml casualty Company oro The Cincinnati Speclelly Underwriters Insurance Company-end life and disability Income Insurance and annuities ~{I through o The Cincinnati Lire Insurance Company. Each Insurer has sole gnanclalresponsibllllyfor its own products. Not all subsidiaries //J 'operate In all states. 6200 SYGilmore Road, FaIr leld, OH 450145141. www.clnfin.cnm ,4A Copyright@ 2012 The Cincinnati Insurance Company. Ali dghtsmserved. Do not post online, in whole or In pad, CINCINNATI ,witgoulwrittenpermission: ~f INSURANCE COMPANIES -Adv_ 694 (7/1Z Ed:2