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HomeMy WebLinkAboutInsurance Certificate: Potelco,Inc AC CERTIFICATE CERTIFICATE OF LIABILITY INSURANCE 5/1/2023 DATE (MMIDD022) 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 LOCKTON COMPANIES CONTACT NAME: 3657 BRIARPARK DRIVE,SUITE 700 PHONE FAX (NC.HOUSTON TX 77042 E-MAILo.Extl: INC.Nol: 866-260-3538 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Old Republic Insurance Company 24147 INSURED POTELCO,INC. INSURER B:ACE Property&Casualty Insurance Co 20699 1364742 A QUANTA SERVICES COMPANY INSURER C: 14103 STEWART RD. SUMNER WA 98390 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 12424201 REVISION NUMBER: XXXXXXX 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MMIDDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY 313093 22 05/01/2022 05/01/2023 EACH OCCURRENCE $ 5,000,000 A MWZX 313095 22 05/01/2022 05/01/2023 CLAIMS-MADE x OCCUR DAMAGE TO PREMISES Ea occurrence) $ 1,000,000 Y N MED EXP(Any one person) $ Excluded PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 POLICYI PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 5,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A MWTB31309222. 05/01/2022 05/01/2023(Eaaccident) $ 5,000,000 A X ANY AUTO MWZX 313091 22 05/01/2022 05/01/2023 BODILY INJURY(Per person) $XXXXXXX X OWNED SCHEDULED Y N INJURY(Per accident)$XXXXXXX AUTOS ONLY —AUTOS p X AUTOS ONLY HIRED X AUTOSNON-OWNED ONLY (Per acoldent)AMAGE $ XXXXXXX $ XXXXXXX B X UMBRELLA LIABX OCCUR XOO G27972032 007 05/01/2022 05/01/2023 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE N N AGGREGATE $ 5,000,000 DED RETENTION$ $ WORKERS COMPENSATION X STATUTE IOER A AND EMPLOYERS'LIABILITY Y/N MWC 313094 22 05/01/2022 05/01/2023 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? N N/A N (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes.describe u^cler DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Re:All Operations General Liability And Auto Liability Policies Include The City Of Ashland,Oregon,And Its Elected Officials,Officers And Employees As An Additional Insured When Required By Written Contract But Only As Respects Liability Arising Out Of Named Insured's Work For Additional Insured. 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. 12424201 AUTHORIZED REPRESENTATIVE The City Of Ashland,Oregon 1 Attn:Kari Ann Olson 1 90 N.Mountain Ave. Ashland OR 97520 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION.All rig is reserved The ACORD name and logo are registered marks of ACORD May 1, 2022 Re: Quanta Services and all Subsidiaries Renewal Certificate of Insurance Dear Certificate Holder: Enclosed for your records you will find the renewal Certificate of Insurance for Quanta Services and its Subsidiaries. To expedite the delivery of future renewal certificates,we are collecting email addresses for all certificate holders. Please note that if no email address is on file,we will continue to mail a certificate of insurance to the mailing address on file. If you wish to receive E-mail version of renewal certificates going forward, please send the email address at which you would like to receive your certificate as well as the Certificate Holder number(see below for directions on how to locate this information)to the following email address: Houston-QuantaECertDelivery@lockton.com Certificate Holder# ERTIFICATE HOLDER — The Certificate Holder number is 12345678 the 8 digit number directly above the Certificate Holder name and 12345678 address in the bottom left corner SAMPLE of your enclosed COI. 123 Main Street Anywhere AL 12345 :ORD 25/20161031 Regards, - 1 ,.l Amy Barnett