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HomeMy WebLinkAboutInsurance Certificate: NW Tank Lining & Inspection Inc AR D® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YWY) 5/16/2022 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 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 JD Fulwiler&Co., Insurance PHONE Vicki Sigler FAX 5727 S Macadam Ave (NC.No.Ext):503-977-5710 (Ac,No):360-735-3145 Portland OR 97239 ADMDRESS: vsigler@jdfulwiler.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Westchester Surplus Lines Ins 10172 INSURED NWTANKL-01 INSURER B NW Tank Lining &Inspection, Inc P.O. Box 883 INSURER C: Sherwood OR 97140 INSURER D: INSURER E INSURER F COVERAGES• CERTIFICATE NUMBER:2053512504 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 ADDL SPOLICY EFF POLICY EXP LTR TYPE OF INSURANCE NW SD VD POLICY NUMBER (MM/DD/YYYY) (MM/DDIYYYIf) LIMITS A X COMMERCIAL GENERAL LIABILITY G72579331 5/14/2022 5/14/2023 EACH OCCURRENCE $3,000,000 CLAIMS-MADE X OCCUR PREMISES Ea occurrence) $300,000 X WA Stop Gap MED EXP(Any one person) $25,000 X see below PERSONAL&ADV INJURY $3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 POLICY X JEC LOC PRODUCTS-COMP/OP AGG $3,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _AUTOS ONLY (Per accident) UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Professional Liability G72579331 5/14/2022 5/14/2023 Limit Per Claim $3,000,000 Claims Made Ded Per Claim $5,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Certificate Holder is included as additional insured as respects operations of the named insured in accordance with the policy terms,conditions&exclusions per form OBENVGE301. 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. City of Ashland 20 E. Main St. AUTHORIZED REPRESENTATIVE Ashland OR 97520 (Attie I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: G72579331 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s)Of Covered Operations As required by written contract, prior to a loss to N/A which this insurance applies Information requiredlto completejthis Schedule, if not shown above,will be shown,in the Declarations. i _ — - • A. Section II = Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insui.ed-the--person(s) or - 'additional—insureds,---the following' additional organization(s) shown in the Schedule, but only exclusions apply: with respect to" liability for and"bodily slag This insurance does not apply to"bodily injury"or "property "property damage"occurring after: injury" caused, in whole or in part, by: 1. Your acts or omissions; or 1. All work, including materials, parts 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 beperformed by or in the performance of your ongoing operations on behalf of the additional insured(s) at the for the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted other than another contractor or by law; and subcontractor engaged in performing 2. If coverage provided to the additional insured operations for a principal as a part of the is required by a contract or agreement, the same project. 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 20 10 0413 © Insurance Services Office, Inc., 2012 Page 1 of 2 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 the required by a contract or agreement, the most we applicable Limits of Insurance shown in the will pay on behalf of the additional insured is the Declarations. amount of insurance: 1. Required by the contract or agreement; or I Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 0413