HomeMy WebLinkAboutInsurance Certificate: Selectron Technologies Inc (2) .-----77.1.® DATE(MM/DDIYYYY)
,acoRo .. CERTIFICATE OF LIABILITY INSURANCE
1/27/2022 •
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'tiolder is an ADDITIONAL INSURED,the policy(ies);musthave ADDITIONAL�INSURED provisions Or-be endorsed; -
, . :If SUBROGATION IS WAIVED;:subject to the terms'and'Conditions of the policy,;ceitain policies may require:an'eridorsement..•Aistatementon_ .._._.
this:,certificate does not confer rights to the;certiricate holder in lieu of such endorsement(s)'. • ;^• ,!.:.',,til (`'9.;
PRODUCER);Rcar(;.,,;r.,^r,: CONTACT h NAME:; Janet Fergus I .'..4o'.t er r" /
?._. .;y t.__. ....._„.,1-.!1°°.1b::)('
FAX
W-B.Adams-Co. PHONE, (503)644-9945 ' •"-- ) !:503 644-9997 '.""'
A/C No,Ext): - _- - -- ...( ..N.._.(__ __ ..-----
,. _• n� f ° E-MAIL. ..... ':<:'.:)c d(.:?. ,'�7,;2•e
ti
nsurance Commerctallz wbadan ei4'-'.'.''' '` -••-+.:;2•eti
ADDRESS: @ -
INSURER(S)
..__...__. ._..-_-
14737-5 W Millikan Way. = ' `°' INSURER(S)AFFORDING_COVERAGE''.,-: ('
NAIL•#,,,:
Beaverton ° OR 97003 INSURER AY Sentinel Insurance-Com an
INSURED ; INSURER B: Hartford Twin City Fire In'sutance"Co''°" 30147 ''
Selectron Technologies,Inc. ' INSURER C: Hartford Accident and Indemnity Company 22357 '
12323 SW 66th Ave INSURER D:
Portland,OR,97223 INSURER E:,
INSURER F:
COVERAGES 'CERTIFICATE NUMBER: . . ' REVISION NUMBER:
-I. 'THIS IS TO CERTIFY THAT'THEPOLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED.ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY,f?EQUIREMENT,.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 AUULSUt3H' POLICY EFF— POLICY EXP I
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY)I LIMITS
COMMERCIAL GENERAL LIABILITY . . EACH OCCURRENCE $ • 1,000,000
CLAIMS-MADE v OCCUR ' PREIuIttIto 1,000,000
A. - _ PREMISES(Ea occurrence) $
K Ongoing and Completed Ops End'
MED'EXP'(Anyone person) $ ''1000
A K 'Primary Endorsement • : . :52SBAR09216 • '', '01/31/2022: 01/31/2023 'PEIjSONAL 8 A0V INJURY $ 1,000,000'
GENL•AGGREGATE LIMIT APPLIES PER: ' ; " '" ' GENERAL AGGREGATE $ ,; 2,000,000
' POLICY JECT. LOG r 4 r PRODUCTS COMP/OP AGG $ 2,000 000
PRO- r
:.
N. 1 tr DTHER" i ' 3e. Deductible_._.__.._. _L_,$'_ t 1,000
4,.,; AUTOMOBILE LIABILITY •�••"'+L• •• ,r EOMBINtli INGLLLIMII $• 1,000,000
�3',. -.m,,,. (a accident_ __ _. ...._ _.._.._ _.-.
,K•ANY AUTO icer. ,'r. C4 hlf) .F..!4 Tr,•, ;'£; ,si:ci I-'?I_i-.. „.'77;� r is t_, uu �. !i4:-.;,.:., BODILY INJURY(Per person) $ • •
Ct {" AUTOS ONLY_ I t AUros LEDs 52UECPT5600' 701/31/2022 01/31/2023;" BODILY INJURY�(Per'accident) $"'
)fa_ HIRED'., I-...,_I:—^ANON'-OWNED .I i- -.0:`' ^'.'-'1:''. ;,+. '' :3d :.'r c., i* t��t SIY• _ - .-
:K:AUTOS.ONCY , X-AUTOS:ONLY ._ -. . . "_, .._. _... •• .. . (Pe accident)'4 k...
MAti .$.
Comp/Collision.,,. ,.$. . 500/500
K UMBRELLA LIAB X OCCUR EACH OCCURRENCE'. . $' ' . . 5,000,000
A EXCESS LIAB CLAIMS-MADE ' 52SBAR09216 01/31/2022 01/31/2023 AGGREGATE $ 5,000,000
- ' DED EX RETENTION$ 40,000 - ' Deductible- — . s - . . " 1,000
WORKERS COMPENSATION _ PERTbrE O I H-
ANDEMPLOYERS'LIABILITY Y/N STAERY
1NY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT. s ,1,000;000;
B OFFICER/MEMBEREXCLUDED? N'/A 52WBCG13039 01/31/2022 01/31/2023 -
• Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
-If yes,dpsc•ihr under- ' - , _
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ - -1,000;000-
. Each Occurrence 2,000,000
A Professional Liability/E&O 52SBAR09216 01/31/2022 01/31/2023 Aggregate • 2,000,000
Limit . 2,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
Data Breach/Cyber Liability Limit:500,000-Sentienel Insurance Company term date 01/31/2022-01/31/2023
.
CERTIFICATE HOLDER.. CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
' THE EXPIRATION DATE THEREOF,NOTICE WILL BE'DELIVERED IN
City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS.
20 E Main Street AUTHORIZED REPRESENTATIVE
Ashland OR 97520 I
POLICY NUMBER: 52 SBA R09216
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL , INSURED ,' PERSON-ORGANIZATION
THE CITY OF ELK GROVE
ITS OFFICIALS, EMPLOYEES, AGENTS, AND VOLUNTEERS
PO BOX 20270
LONG BEACH CA 90801
CITY OF DETROIT PURCHASING DIVISION
COLEMAN A YOUNG MUNICIPAL CENTER
SUITE 1008
DETROIT, MI 48226
CITY OF FRESNO
C/O ISD
2600 FRESNO ST..;. ROOM 1059 .
FRESNO, CA 93721
bpo
20 EAST MAIN STREET
ASHLAND, OR 97520
Form IH 12 00'11 85'T SEQ. NO. 003 Printed in U.S.A. Page 002 (CONTINUED. ON NEXT PAGE)
Process Date: 11/01/21 Expiration Date: 01/31/23
POLICY NUMBER: 52 SBA R09216
tv
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - PERSON-ORGANIZATION
THE CITY OF ATLANTA
68 MITCHELL ST
ATLANTA, GA 30303
CITY OF AMARILLO
ATTN: PURCHASING DEPARTMENT
P 0 BOX 1971
AMARILLO, TX 79135
CITY OF NOVATO
75 ROWLAND• WAY. #2:00• • •
NOVATO, CA 94945-5054
CITY OF OCEANSIDE
300 NORTH COAST HWY . •
OCEANSIDE, CA 92054
CITY OF PORTLAND
1120 'SW 57t.H';AVE ROOM 750
PORTLAND," OR 97204
CITY OF SANTA ANA
RISK MANAGEMENT DIVISION, 4TH FLOOR
20 CIVIC CENTER PLAZA
SANTA ANA, CA 92701
COUNTY OF PLACER
C/O EBIX BPO
P 0 BOX 257 '
PORTLAND, MI 48875
. . FULTON COUNTY GOVERNMENT DEPARTMENT OF PURCHASING & CONTRACT
COMPLIANCE
130 PEACHTREE STREET SW. SUITE 1168
ATLANTA, GA 30303-3459
PLACER COUNTY WATER AGENCY
P-'0-'BOX''6 5 7 0
AUBURN'W' CA'.95604
.
•
- Form IH 12'00 1185 T SEQ. NO. 003 Printed in U.S.A. Page 001 (CONTINUED ON NEXT PAGE) •
Process Date: 11/01/21 Expiration Date: 01/31/23 •
• • . •