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HomeMy WebLinkAboutInsurance Certificate: F.D. Thomas Inc ACCP U CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 1/20/2022 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 Alliant Insurance Services Houston, LLC PHONE FAX 5444 Westheimer RD 9th fl (A/c.No.Ext): (832)485-4000 (A/C,No):(832)485-4001 Houston TX 77056 ADDRESS: arctic.certs@alliant.com INSURER(S)AFFORDING COVERAGE NAIC# License#:0C36861 INSURER A:ACE American Insurance Company 22667 INSURED ARTCSLO-01 INSURER B:Tokio Marine Specialty Insuran 23850 F.D.Thomas, Inc. 217 Bateman Dr INSURER C:ACE Property&Casualty Insure 20699 Central Point,OR 97502 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1370074609 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. ILTRR TYPE OF INSURANCE INSD SUBR POLICY NUMBER POLICY POLICY EXP LIMITS (MM/DD/YYYYI (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY Y HDOG72472421 .6/1/2021 6/1/2022 EACH OCCURRENCE $3,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $100,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $3,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 POLICY X JEOT LOC PRODUCTS-COMP/OP AGG $3,000,000 OTHER: $ A AUTOMOBILE LIABILITY ISAH08874785 6/1/2021 6/1/2022 COMBINEDaaccdent)SINGLE LIMIT $5,000,000 (E 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) Comp/Coll Ded $1,000 C X UMBRELLA LIAR X OCCUR XOOG28122676006 6/1/2021 6/1/2022 EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 DED X RETENTION$r,npnn $ A WORKERS COMPENSATION WLRC68930522 6/1/2021 6/1/2022 X STATUTE ERH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $2,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $2,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $2,000,000 B Contractors Pollution Liability PPK2275163 6/1/2021 6/1/2022 Per Incident $5,000,000 Aggregate Limit $5,000,000 • DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may:be attached if more space Is required) See Attached... 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 Street AUTHORIZED REPRESENTATIVE Ashland OR 97520 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: ARTCSLO-01 ,---""""NLOC#: AW ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Alliant Insurance Services Houston,LLC F.D.Thomas, Inc. 217 Bateman Dr POLICY NUMBER Central Point,OR 97502 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE INSURER AFFORDING COVERAGE:Berkley Assurance Company NAIC#:39462 POLICY NUMBER:PCAB-5013807-0221 EFF DATE:02/14/2021 EXP DATE:06/01/2022 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Professional Liability Each Claim $5,000,000 Aggregate Limit $5,000,000 FDT Job Number:70862;FDT Job Name:City of Ashland-Effluent Launder Clarifier Coverage for Contractual Liability is provided under General Liability policy. The City of Ashland,Oregon,its officers,agents and employees are included as Additional Insureds as respects to General Liability. General Liability policy shall be Primary to any other insurance in force for or which may be purchased by Additional Insureds. • ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 66 POLICY NUMBER: HDO G72472421 Endorsement Number: COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations Any person or organization whom you have agreed to All locations where you are performing ongoing include as an additional insured under a written operations for such additional insured pursuant to any contract, provided such contract was executed prior to such written contract. the date of loss. Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage"occurring after: caused, in whole or in part, by: 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the 1. The insurance afforded to such additional injury or damage arises has been put to its intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. required by a contract or agreement, the C. With respect to the insurance afforded to these insurance afforded to such additional insured additional insureds, the following is added to will not be broader than that which you are Section III—Limits Of Insurance: required by the contract or agreement to provide for such additional insured. If coverage provided to the additional insured is required by a contract or agreement, the most we CG 20 10 0413 © Insurance Services Office, Inc., 2012 Page 1 of 2 will pay on behalf of the additional insured is the whichever is less. amount of insurance: This endorsement shall not increase the 1. Required by the contract or agreement; or applicable Limits of Insurance shown in the 2. Available under the applicable Limits of Declarations. Insurance shown in the Declarations; Page 2 of 2 ©Insurance Services Office, Inc., 2012 CG 20 10 0413 1 NOTICE TO OTHERS ENDORSEMENT-SCHEDULE Named Insured Arctic Slope Regional Corporation Endorsement Number 43 Policy Symbol Policy Number Policy Period Effective Date of Endorsement ISA H08874785 06/01/2021 TO 06/01/2022 . Issued By(Name of Insurance Company) ACE American Insurance Company Insert the policy number.The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. A. If we cancel the Policy prior to its expiration date by notice to you or the first Named insured for any reason other than nonpayment of premium, we will endeavor, as set out below, to send written notice of cancellation, via such electronic or other form of notification as we determine, to the persons or organizations listed in the schedule that you or your representative provide or have provided to us (the "Schedule"). You or your representative must provide us with the physical and/or e-mail address of such persons or organizations, and we will utilize such e-mail address or physical address that you or your representative provided to us on such Schedule. B. The Schedule must be initially provided to us within 15 days after: i. The beginning of the Policy period, if this endorsement is effective as of such date; or ii. This endorsement has been added to the Policy, if this endorsement is effective after the Policy period commences. C. The Schedule must be in an electronic format that is acceptable to us; and must be accurate. D. Our delivery of the notification as described in Paragraph A. of this endorsement will be based on the most recent Schedule in our records as of the date the notice of cancellation is mailed or delivered to the first Named Insured. E. We will endeavor to send or deliver such notice to the e-mail address or physical address corresponding to each person or organization indicated in the Schedule at least 30 days prior to the cancellation date applicable to the Policy. F. The notice referenced in this endorsement is intended only to be a courtesy notification to the person(s) or organization(s) named in the Schedule in the event of a pending cancellation of coverage. We have no legal obligation of any kind to any such person(s) or organization(s). Our failure to provide advance notification of cancellation to the person(s) or organization(s) shown in the Schedule shall impose no obligation or liability of any kind upon us, our agents or representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Policy. G. We are not responsible for verifying any information provided to us in any Schedule, nor are we responsible for any incorrect information that you or your representative provide to us. If you or your representative does not provide us with a Schedule, we have no responsibility for taking any action under this endorsement. In addition, if neither you nor your representative provides us with e-mail and physical address information with respect to a particular person or organization, then we shall have no responsibility for taking action with regard to such person or entity under this endorsement. H. We may arrange with your representative to send such notice in the event of any such cancellation. I. You will cooperate with us in providing the Schedule, or in causing your representative to provide the Schedule. J. This endorsement does not apply in the event that you cancel the Policy. ALL-32687(05/11) Page 1 of 2 All other terms and conditions of the Policy remain unchanged. Authorized Representative ALL-32687(05/11) Page 2 of 2 34 POLICY NUMBER: HDO G72472421 001 Endorsement Number: 81 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR • CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Any person or organization whom you have agreed to All locations where you perform work for such additional include as an additional insured under a written insured pursuant to any such written contract contract, provided such contract was executed prior to the date of loss Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Section II — Who Is An Insured is amended to will not be broader than that which you are include as an additional insured the person(s) or required by the contract or agreement to provide organization(s) shown in the Schedule, but only for such additional insured. with respect to liability for "bodily injury" or B. With respect to the insurance afforded to these "property damage" caused, in whole or in part, by additional insureds, the following is added to "your work" at the location designated and Section III—Limits Of Insurance: described in the Schedule of this endorsement If coverage provided to the additional insured is performed for that additional insured and required by a contract or agreement, the most we included in the "products-completed operations will pay on behalf of the additional insured is the hazard". amount of insurance: However: 1. Required by the contract or agreement; or 1. The insurance afforded to such additional 2. Available under the applicable Limits of insured only applies to the extent permitted Insurance shown in the Declarations; by law; and 2. If coverage provided to the additional insured whichever is less. is required by a contract or agreement, the This endorsement shall not increase the applicable insurance afforded to such additional insured Limits of Insurance shown in the Declarations. CG 20 37 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1