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HomeMy WebLinkAboutInsurance Certificate: Olsson Industrial Electric Inc dba OS Engineering (2) • NAESCOR-02 LWANG2 AC0 L CERTIFICATE OF LIABILITY INSURANCE DATErJ(MMIDD22rn 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 Certificate Requests NAME: Alliant Insurance Services,Inc. PHONE FAX - 10 Almaden Boulevard,Suite 650 (NC,No,Ext):(408)352-6700 (A/C,No): San Jose,CA 95113 E-MAIL s certificates@/�alliant.com �ADRE_s% � L: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Zurich American Insurance Company 16535 INSURED INSURER B:American Guarantee and Liability Insurance Company 26247 Olsson Industrial Electric,Inc.dba OS Engineeing INSURER C:American Zurich Insurance Company 40142 1180 NW Maple Street,Suite 200 INSURER D:North American Capacity Insurance Company 25038 Issaquah,WA 98027 INSURER E:Berkley Assurance Company 39462 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 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD IMMIDD/YYYY) IMMIDD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE X OCCUR GLO 5574116-09 5/20/2022 5/20/2023 DAMAGE TO RENTED 1,000,000 X P$EMISESIEa occurrence) $ MED EXP(Any one person) $ Included PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 4,000,000 POLICY X PELT LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 2,000,000 _(Ea accident) X ANY AUTOX BAP 983019142 5/2012022 5/20/2023 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOSEONLY AUTOSBODILY� INJURYp (Per accident) $ AUTOS ONLY AUTOS ONLY (Per a�ident)AGE Comp/Coll Ded $ 5,000 B UMBRELLA LIAB X OCCUR EACH OCCURRENCE J 10,000,000 X EXCESS LIAR CLAIMS-MADE AUC 355245-02 5/20/2022 5/20/2023 AGGREGATE $ 10,000,000 DED X RETENTION$ 10,000 $ C WORKERS COMPENSATION AND EMPLOYERS'LIABILITY X PER ERH ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WC 5574117-09 5/20/2022 5/20/2023 E.L.EACH ACCIDENT $ 2,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE,$ 2,000,000 I1 yes,describe under 2,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ D Cyber Liability C-4LXD-063362-CYBER-2022 5/20/2022 5/20/2023 Each Claim/Aggregate 1,000,000 E POLLUTION LIABILITY PCAB-5018181-0522 5/20/2022 5/20/2023 Each Occ/Aggregate 5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) The City of Ashland,Oregon and its elected officials,officers and employees are incuded as additional insured where required by written contract and allowed by law with respect to General Liability and Auto Liability. This insurance shall be primary and non-contributory and limited to liability arising out of the operations of the named insured when required by written contract. Employers Liability includes stop gap coverage for monopolistic states. Stop Gap is included in the(AOS)WC policy: • • CERTIFICATE HOLDER CANCELLATION • SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main Street Ashland,OR 97520 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD - •