HomeMy WebLinkAboutInsurance Certificate: Federal Resources Supply Co.Client#: 1545117 FRSHOLI
DATE (MM/DD/YYYY)
ACORD,, CERTIFICATE OF LIABILITY INSURANCE 12/10/2019
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(ies) must have ADDITIONAL INSURED provlslons 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 NAME: Debbie Archimbaud
USI Insurance Services, LLC PHONE 984-255-1065 FAX 877-506-0509
ac No Ext : ac No
8540 Colonnade Center Dr. E-MAIL ADDRESS: debble.archlmbaud@usi.com
Suite 111 INSURER(S) AFFORDING COVERAGE NAICt
Raleigh, NC 27615 Great Northern 20303
INSURER A : pNr
INSURED INSURER B : Federal Insurance Company 20281
Federal Resources Supply Company INSURER C Twin City Fire insurance company 29459
235G Log Canoe Cir Trumbulllnsuran�eCom 27120
INSURERD: Pant'
Stevensville, MD 21666-2165
INSURER E
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 CONTRACTOR 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.
RR
TYPE OF INSURANCE
INSR
WVD
POLICY NUMBER
35894855
MMI/DDCDY EFF
MM/DDnFY.XP
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
2/01/2019
12/01/2020
$1,000,000
CLAIMS -MADE u OCCUR
pDEAAqCC�HHOEECTCURpRENCE
PREMES E,RENTED
I occurrence
$1 000,000
MED EXP (Arty one person)
$10 000
PERSONAL & ADV INJURY
$1 OOO 000
GENERAL AGGREGATE
$2,000,000
GEN'L
AGGREGATE LIMIT APPLIES PER:
POLICY I ECT I LOC
PRODUCTS - COMP/OP AGG
$ 2 OOO OOO
$
OTHER:
D
AUTOMOBILE
LIAB1U` Y
22UENBH6529
2/01/201912/01/202
COMBINED SINGLE LIMIT
Ea,xldant
1,000,000
X
BODILY INJURY (Per person)
$
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED ONLY X NON -OWNED
AUTOS ONLY
X
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
$
B
X
UMBRELLA LIAB X OCCUR
79832965
12/01 /2019
12/01/2020
EACH OCCURRENCE
-----
$1 000
��0 OOO
AGGREGATE
EXCESS LIAB CLAIMS -MADE
$10 000 000
DED RETENTION
$
`+
,ANY
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
PROPRIETOR/PARTNER/EXECUTIVE �Y / N
OFFICERIMEMBER EXCLUDED? � • 1
(Mandatory in NH)
N / A
22WBAC30CU
2/01/201912/01/202
X S7AUTE ER_
E.L. EACH ACCIDENT
- -
$100 0O00
E.L. DISEASE - EA EMPLOYEE
$1 000 000
E.L. DISEASE -POLICY LIMIT 1
$1 000 000
If yes, describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
The City of Ashland, Oregon is included as additional insured for General Liability, Automobile Liability,
and Professional Liability as their interest may appear as required by written contract. General Liability,
Automobile Liability, and Professional Liability coverage is primary and non-contributory.
The City of Ashford, Oregon
20 East Main Street
Ashland, OR 97520-0000
A.A"L.CLLA 1 ILJN
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
C 1988-2015 ACORD CORPORATION. All rights reserved.
and logo are registered marks of ACORD
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