HomeMy WebLinkAboutInsurance Certificate: Selectron Technologies Inc •
�.® DATE(MM/DD/YYYY)
A RD CERTIFICATE OF LIABILITY INSURANCE
1/27/2022 •
THIS CERTIFICATE IS ISSUED AS AMATTER 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. TI-US 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 terns and'c`onditions of the policy;.certain"polit:ies may're'quiFe'akeridorsemenC A+statement on. ..._:_..
this:certificate does not confer rights to the certificate holder in lieu of such endorsement(s)'. "`D'•%.'i'^r I•c ;
.,,.PRODUgERy,y-.cn'(c,;.S"+ :•, i NAME l l Janet-Fergus t,r.,4v { r j �`'. I t,,
W B Adams Co PHONE,
/C No,Ext): (503)644-9945 ',c� A/C,M9) ''(593)6449997 ''°�
r ..' .ura -ren t ° -MAIL. t ,, "'
Genera)IriSUYanCe �'` , - ADDRESS: CommergiallZ@wbadams CONI �' ` ' �n �U.,
14737-SW Millikan Way " INSURERS)AFFORDING_COVERAGE' V V.
" '" NAIe#-j"U
Beaverton " ': -- ': -0&'97003 INSURER A:'.Sentinel Insurance ' 11000.3"C
INSUREDINSURER B: Hartford Twin City Fire InsdtanceCo' ' 30147
Selectron Technologies,In.c. 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: '
• 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,REQUI,REMENT;"TERM..QR 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. •
INS TYPE OF INSURANCE AUULJUtsR POLICY EFF POLICY bXP
INSD WVD • POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
K COMMERCIAL GENERAL LIABILITY , EACH OCCURRENCE $ • 1,000,000
CLAIMS-MADE OCCUR ' PREMIS I a occurrence)I 1,000,000
-y�/
A. PREMISES(Ea $
, x Ongoing and Completed Ops End' ; MED'EXP"(Any one person) $ ' 10,000 ,
'A K Primary Endorsement ' '52SBAR09216 ' -- ''' '•01/31/2022• 01/31/2023 PERSONAL&ADV INJURY $ 1,000,000
: GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE"__ $ 2,000,000
•- 'x POLICY- 'n8=_ LOC ' I- 'r r ` , - I - -„ 0.k DUCTS COMP/OP AGG $ - 2,000,000;
it','
? \ DTHER' ., I r,r, T. ' ..:''.i,_'. Deductible '' $•.:,•:-I.:-":-11:. 1 000
t,,,it AUTOMOBILE LIABILITY ' +t_• L MtisidSINGLE LIMI I
3, aacciden $ ._,.. .._.".1,000,000
•
;,, „)c•ANYAUTOq rF t. ,g t 1x.,t.f4+p34 p, fr•. a `:)'+' -'t' "" 1, , i I,-,?..,:i'...i.:,,,;.,: a BODILY INJURY(Per person) $
Cl Ii.OWNES O E-`: 1:'-' (e, SCHEDULED n S2UECPT5600 0l/31/2022 01/31/2023 BODILY IN IURY'(Per'actildent) $'
5,d HIREDS'ONCY I : 'NON OWNED • ;-., -. .!-, 1.,' ,. .t ',1' < % ''NF� 'lY•J.MAGEi:..,
/�.AUTOS ONL1 /►AUTOS'ONLY • (Peraccciident
Comp/Collision:,;' $ 500/500
x UMBRELLA LIAB K OCCUR - : • EACH OCCURRENCE:'. _ , $' ' , - . 5,000,000
A EXCESS LIAR CLAIMS-MADE ' 52SBAR09216 01/31/2022 01/31/2023 AGGREGATE $ 5,000,000
1 •
_
I - _t.
DED RETENTION$ 40;000 Deductible — . " ' ' " `- 1,000
WORKERS COMPENSATION � ' PER O 1 H-
AND EMPLOYERS'LIABILITY /� STA t.UTE ER
1NY PROPRIETOR!?ARTNER/EXECUTIVE YJ N I E.L.EACH ACCIDENT. $- " 1,000 QO0,,
B oFFICER/MEMBEREXCLUDED7 N/A 52WBCGI3039 01/31/2022 01/31/2023
• C(Mandatory in NH) _ •" E.L.DISEASE-EA EMPLOYEE $ 1,000,000
,I If yes,dr sc iKo under- ' - _. ._ _ _ .. I
DESCRIPTION OF OPERATIONS below . EL.—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 POLICIESBi 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
4',50-0-.--'
I Ashland OR 97520
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
voSITOYANECHurrakib
20 EAST MAIN STREET •
ASHLAND, OR 97520
•
Form IH 12 0011 85'T SEQ. NO. 003 Printed in U.S.A. Page 002 (CONTINUED. ON NEXT PAGE)
:.Ptocess Date .11/01/21 Expiration Date: 01/31/23
POLICY NUMBER: 52 SBA R09216
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
112b" SW 5TH'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-'01"BOX' 6570
AUBURN;- 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