Loading...
HomeMy WebLinkAboutInsurance certificate: Auma Actuators Inc ACORD® DATE,(MM/DDIYYYY) CERTIFICATE OFLABIIYNSRANCE4...i.,---- INSURANCE 1/117 on 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 holderis an ADDITIONAL INSURED,the policy(ies)must haveADDITIONAL INSURED provisionsor be endorsed. If SUBROGATION IS WAIVED,subject•to the terms and:conditlo'ns of the policy,certaimpollcies,may require an endorsement. A.:statement on this certlflcate.does notconfer_rlghts to the certificate holder in,Ileu:ofsuchendorsement(s)., ._ . . .. ..., . ,.. . ... ..... .. . . .. . . ., PRODUCER CONTACT • Arthur J.Gallagher Risk ManagementNAME: Josh Miller Services inc. PHONE' FAX ' I P,asquerilla Plaza, ' (AIC.No.EM) 412 209-4428 ., .(ac,No):8147536-5554. E•MAIC .. Suite 100 . .ADDRESS: josh_miller1Aajg.com Johnstown PA 15901 • 'INSURER(S)AFFORDINGCOVERAGE' NAIC# INSURER A:HDI-Global InsuranceCorpany 41343 INSURED AU•MAACT-o2'INSURERS:Travelers IndemnityConipany. 25658• AUMA Actuators,Boc. Ul INSURER C:Phoenix Insurance Company 25623 • 100 Sou'thpointe Boulevard Canonsburg PA'15317 INSURER.D: •INSURER'E: INSURER: .COVERAGES CERTIFICATE NUMBER:'1.590015319 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 HAVEBEENREDUCED BY PAID CLAIMS. INSR ADDL sUBR POLICY:EFF POLICY EXP --- - LTR TYPE OF INSURANCE INSO,*VD POLICY NUMBER (MMIDDIYY•YY)-(MM/DD/YYYY)+ LIMITS . A X' COMMERCIAL GENERAL LIABILITY Y GLD,10669,14 1/1'12022, • 1/1/2023 :EACH OCCURRENCE $'1,000,000 , CLAIMS-MADE X OCCUR PREM SES Ea occU GE TO RENTED $100,000 MED EXP(Anyone person) $5,000 PERSONAL'&ADVINJU.RY $1,000;000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000' • X POLICY PROT- LOC PRODUCTS COMP/OP AGG $'1;000,000 JEC OTHER: $ B AUTOMOBILEUABIUTY Y BA9N7472.6721143 12/31/2021 12/31/2022 ;COa'MBWtlenED.tSINGLELIMIT' $1;000,000• (Ecdl X ANY,AUTO BODILY INJURY(Per.person). $. X OWNED SCHEDULED BODILYINJURY(Peraccident) $ AUTOS ONLY AUTOS' X HIRED x NON-OWNED PROPERTY DAMAGE. $, AUTOS'ONLY _AUTOS ONLY (Per,accident)' $ • A X UMBRELLALIAB X OCCUR CUD1067014,. ' 1/1/2022, 1/172023 EACH OCCURRENCE.. .$.4;000,000 ' EXCESS UAB CLAIMS-MADE : AGGREGATE _ $4,000,000 DED x .RETENTION$'innnn $' C WORKERS COMPENSATION Y.Y N UBOK2283602114G 12/31/2021 12/3172022 X PERATUTE ER OTH ITY ST - AND EMPLOYERS'LIABIL ANYPROPRIETOR/PARTNER/EXECUTIVE � E.L.EACHACCIDENT $1,000,000 OFFICERIMEMBEREXCLUDED2 I I NIA (Mandatory In,NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 II yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE=POLICY LIMIT $1,000,000. DESCRIPTION OF OPERATION$'/LOCATIONS'I VEHICLES(ACORD 101,Additional Remarks.Schedule,may be,atlached If more space Is required) The City of Ashland,Oregon;its officers,agents and employees are additional insured on the General.Liability policy'as per form#CG 20 10,edition.04/13 and on the Auto Policy as,per form.#.CA T3 53,edition 02/15,The Umbrella policy:is follow form in regards to additional Insured provision'as„per form#CU 00 01, • edition 04/13.The.Workers'.Compensation poiicy'is Evidence of Coverage CERTIFICATE HOLDER ..CANCELLATION • SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ' THE, EXPIRATION' DATE• THEREOF, 'NOTICE WILL BE DELIVERED IN ACCORDANCE WITH'THE POLICY PROVISIONS: City of Ashland 20 East Main Street . Ashland VE Ashland OR 97520 i'' ©1988-2015 ACORD CORPORATION. All rights:reserved. ACORD 25(2016/03) The ACORD name and Logo:are':TegIstered marks of ACORD 2•of 6 5212 POLICY NUM BER:GLD1066913 COMMERCIAL'GENERAL LIABILITY CG 20 37 04 13 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 ROD CT (aMPLE D 0 ERAIROM LIABILIT 11RAGE 'AR SCHEDULE Name Of Additional Insured,person(s) Or Organization(s) Location And.Description Of Completed Operations ANY PERSON OR,ORGANI ZATI ON ANY LOCATION WHERE REQUIRED WHERE REQUIRED BY WRITTEN BY WRITTEN CONTRACT CONTRACT _Information:required to complete this Schedule, if not shoWri,above,Will be shown in the Dedlarations. —J 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 Is added to organization(s) shown in the 'Schedule, but Only, Section T11- Limits Of insurance! with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage"caused, in:whole be in pert, by required by a contract or agreement, the most we 'your work" at the location designated and will pay oh behalf of the additional insured is the described in the Schedule Of this endorsement amount of insurance: performed for that additional insured and included in the 'products-completed operations 1. Requiredby the contract or agreemen;tor hazard". 2. Available: under the applicable Limits of However: Insurance shown in the Declarations; 1. The insurance afforded to such, additional whichever is less, insured only applies to the extent permitted by This endorsement shall not increase the applicable law;and Limits of Insurance shown in the Declarations., 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additionalinsured will not be broader than, that which you are required. 'by the contract or agreement to provide for such additional 'insured. CG 20.37 04 13 © Insurance Services Office, Inc., 2012 Page 1 oft 3*of 6 5212 POLICY NUMBER: GLD10669;1'3 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY.:PLEASE READ IT CAREFULLY. ADDITION:A. L INSURED- OWNE:RSS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsernent modifies insurance;provided.under the;follIowing COMMERCIAL.GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s)Of;Covered Operations, ANY PERSON OR ORGANIZATION ANY LOCATION WHERE: REQUIRED WHERE REQUIRED BY WRITTEN BY WRITTEN CONTRACT CONTRACT Information required to complete this Schedule,if nQt allkwn above, will ke shown..in the Declarations. J 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 andadvertising 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„our onooi o o®eration on behalf of the additional insureds) at the the additional insured(s) at the ' locations) location of the covered operations has been designated above. completed; or However 2. That `portion of "your work' lout of which the 1. The. insurance afforded to. such. additional injury or damage; arises :has been put to its intended useby 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 principal as a part of thesame project is required by a. contract or agreement the insurance afforded to such additional insured. will not be broader than that which you are required by the contract or agreement to provide:for such additional insured. CG 20100413 , ©Insurance Services Office, Inc., 2012 Page 1'of2` 4'of 6 5212 C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown in the'Declarations; Section III-Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase,theapplicable required by a contract or agreement, the most We Limits of Insurance shown in the Declarations will pay on behalf of the .additional insured is the amount of insurance: 1. Required by the contract or agreement; or Page 2 of 2 ©Insurance Services Office;Inc.,2012 CG 20100413 5of6 5212 COMMERCIAL AUTO • THIS'ENDORSEMENT CHANGES-THE POLICY. PLEASE READ IT CAREFULLY. • BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS:AUTO COVERAGE FORM • GENERAL DESCRIPTION OF COVERAGE.-This endorsement broadenscoverage. However, coverage for any injury, damage or medical expenses described in any of the provisions.of this endorsement may be excluded or limited by another endorsement to the:Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an'endorsement. The following listing Is a general cover- age description only. Limitations and exclusions may apply to these coVerages.'Read all the provisions of this'en- dorsement and the rest of your policy carefully to determine rights, duties,,and what is and is not coverecl. A. BROAD FORM NAMED INSURED H. HIRED AUTO'PHYSICAL DAMAGE.- LOSS OF USE B. BLANKET ADDITIONAL INSURED -INCREASED LIMIT L PHYSICAL DAMAGE - TRANSPORTATION C. EMPLOYEE HIRED AUTO EXPENSES-INCREASED LIMIT D. EMPLOYEES AS INSURED J. PERSONAL PROPERTY • E. SUPPLEMENTARY PAYMENTS - INCREASED K. AIRBAGS LIMITS L. NOTICE AND.KNOWLEDGE OF ACCIDENT OR F. HIRED AUTO - LIMITED WORLDWIDE COV- LOSS ERAGE-INDEMNITY BASIS. M. BLANKET WAIVER OF SUBROGATION G. WAIVER OF DEDUCTIBLE-GLASS N. UNINTENTIONAL ERRORS OR OMISSIONS PROVISIONS A. BROAD FORM NAMED INSURED this insurance applies and only to the extent that The following is added to Paragraph A.1.,Who i person, or organization qualifies as.an "insured" An Insured, of SECTION 11-COVERED AUTOS under the Who Is An Insured provision contained LIABILITY COVERAGE: in Section IL . Any organization you newly acquire or form dur- 'C EMPLOYEE HIREDAUTO ing the policy period over which you maintain - 1. The following is added to Paragraph 50% or more ownership interest and that Is not Who Is An Insured, of SECTION II - coy- EREDAUTOS LIABILITYCOVERAGE: - , separately Insured for Business Auto CoVerage. Coverage under this provision is afforded only un- An "employee" of yours is an "insured"while tilthe 180th day after you acquire or form the or- operating an. "auto" hired or rented under a ganiiation or the end of the policy peried, which. contract or agreement in. an: "employee's" ever is earliername, with your permission, while performing dutieso related to the conduct of your busi- • B. BLANKET,ADDITIONAL INSURED nes% The following is added. to Paragraph c,, in A.1., 2. The following replaces Paragraph .b. in 0.5., Who Is An Insured, of SECTION II -COVERED Other Insurance, of SECTION IV - BUS!- AUTOS LIABILITY COVERAGE: 'NESS AUTO CONDITIONS: . ' Any person or organization who required under 'bFor Hired AutoPhysical Damage 'Cover- a written contract or agreement between you and age, the following are.deemed to be coV- that person or organization, that is signed and ered"autos"you own: executed by you before the "bodily injury" or (1) Any covered "auto" you lease, hire, "property damage" occurs and that is In effect rent or borrow; and during the policy period, to be named as an addi- (2) Any covered "auto hired or rented by tional insured is an "insured" for Covered Autos your employee" under a contract in Liability Coverage, but only for damages to which an "ernployee's" name; with your CA T3 63 02 16 6 201 5The Travelers Indemnity Oompany.All rights reserved. Page 1 of 4 Includes copyrighted material of insurance Services Office,Inc.iivith.lts permleslon. • 6*of 6 5212 Arthur J.Gallagher Risk Management Services, Inc. 1 Pasquerilla Plaza, Suite 100 Johnstown, PA 15901 • 52122MB0.482 5212 iiIIIIIiiIIIuIIuIIIiIIIiirIIIIIuIuIIIIuIIuImltuIIIIIIIIIIIiuiI CITY OF ASHLAND 20 E MAIN ST ASHLAND, OR 97520-1814 • We are providing you with a Certificate of Insurance confirming our client's coverage'. Want to get certificates of insurance faster? "Go Green with Gallagher" by receiving digital copies of certificates via e-mail in the future.Or, do you no longer require a certificate of insurance for our client? Please contact us at COI.UpdateMyEmail@AJG.com and provide the following information for processing: 1. Confirmation that a certificate of insurance is no longer required;or 2. E-mail address to send future certificates of insurance in lieu of U.S. Mail delivery 3. Insured Code found in the Insured section on the enclosed certificate.An example of this code is XXXXXX-01 4. This Certificate Number: 1590015319 To learn more about the Insurance and Risk Management Services offered by Gallagher, please visit us at www.ajg.com/us/about-us/how-we-work/core-360. Gallagher does not share your e-mail as detailed in our privacy policy found"at https://www.ajg.com/us/privacy-policy/.. 1'of 6 5212