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HomeMy WebLinkAboutInsurance Certificate: Altec Industries Inc Ac REP® DATE(MM/DD/YYVY) l v CERTIFICATE OF LIABILITY INSURANCE 05/17/2023 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 Bridgette Taul McGriff Insurance Services,LLC P.O.Box 10265 (A/CNNo.Ext):E 1-800 476-2211 (A/C,No): Birmingham,AL 35202 E-MAIL ADDRESS:btaulmriff.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Lexington Insurance Company 19437 INSURED INSURER B:Hartford Fire Insurance Company 19682 Altec Industries,Inc. ' 1450 N 1st.Street INSURER C AIG Specialty Insurance Company 26883 Dixon,CA 95620 INSURER D:Trumbull Insurance Company 27120 INSURER E:Hartford Accident and Indemnity Company 22357 INSURER F: COVERAGES CERTIFICATE NUMBER:C2W2SWPE 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 I POLICY EFF POLICY EXP , LIMITS LTR IN D WVD POLICY NUMBER (MM/DD/YYYY)1(MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY 013136094 06/01/2023 06/01/2024 EACH OCCURRENCE $ 5,000,000 DAMAGE TO RENTED3,000,000 CLAIMS-MADE X OCCUR 1 PREMISES(Ea occurrence) $ MED EXP(Any one person)_ $ N/A X PERSONAL&ADV INJURY $ - 5,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,000 X POLICY JECT PRO LOC PRODUCTS-COMP/OPAGG $ 10,000,000 OTHER: $ B AUTOMOBILE LIABILITY 21CSES27903 06/01/2023 06/01/2024 COMBINED SINGLE LIMIT 5,000,000 (Ea accident) $ - X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED X BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X AUTHIREDOS ONLY X NONAUT-OS OOWNENLY D PROPERTY DAMAGE (Per accident) $ _ - I $ C X UMBRELLA LIAB X OCCUR 031374797 06/01/2023 06/01/2024 EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED RETENTION$ $ D WORKERS COMPENSATION 21 WNS27900(AOS) 06/01/2023 06/01/2024 X STARUTE OTH- ER E AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 21XWES27902(AL,MO,NC) E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I $ ‘ • $ $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:Service,Maintenance,or Repair The City of Ashland,Oregon,its officers,agents and employees are additional insured under General Liability and Automobile Liability on a primary and non-contributory basis as required by written contract.See cancellation endorsement form attached. • 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 , AUTHORIZED REPRESENTATIVE 20 East Main Street Ashland,OR 97520 ifg-) Page 1 of 7 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 21 CSE S27903 COMMERCIALAUTO CA 20 48.02 99 THIS ENDORSEMENT CHANGES.THE POLICY.PLEASE READ IT CAREFULLY. DESIGNATED:-INSURED This endorsement modifies,insurance provided under the following: BUSINESS.AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement,the provisions of the Coverage Form apply unless modified by this endorsement: This endorsement identifies person(s) or organizations)who are"insureds"under the Who Is An Insured.Provision of the Coverage Form. This endorsement does not alter coverage provided.in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement effective r Named insured Countersigned by ALTEC, INC. (Authorized Representative) SCHEDULE Name of person(s)or Organization(s): Any person or organization that you are required to include as an 'additional insured on this coverage form in a written contract or agreement that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period. • (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. • CA 29 48 02 99 Copyright, Insurance Services Office, Inc.;1998 Page 1 of 1 Page 2 of 7 i‘. _ _ _ : C2W2SWPE ,. ._ . Y _ Altec, Inc. Policy No. 21CSES27903 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO CERTIFICATE 'HOLDER(S) This policy is subject to the following additional on file with the agent of record will be sufficient Conditions: proof of notice. If this policy is cancelled by the Company, other Any notification rights provided by . this than for nonpayment of premium, notice of such endorsement apply only to active certificate cancellation will be provided to the certificate holder(s) who were issued a certificate of holder(s) with mailing addresses on file with the insurance applicable to this policy's term. agent of record. Such notice will be provided Failure to provide such notice to the certificate within 30 days of the Company's receipt of holder(s) will not amend or extend the date the certificate holder(s) information from the agent of cancellation becomes effective, nor will it negate record. cancellation of the policy. Failure to send notice If notice is mailed, proof of mailing to the last shall impose no liability of any kind upon the known mailing address of the certificate holder(s) Company or its agents or representatives. Form IH 0310 06 11 Page 1 of 1 © 2011,The Hartford Page 3 of 7 C2W2SWPE 1 / � ENDORSEMENT, This endorsement, effective 12:01 A.M., Forms a part of Policy No.: 013136094 Issued to: Altec,Inc. Attn: Mark Bertovic By: LEXINGTON INSURANCE COMPANY ADDITIONAL INSURED REQUIRED BY WRITTEN CONTRACT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY POLICY A. Section II — Who Is An Insured is amended to include any person or organization you are required to include as an additional insured on this policy by a written contract or written agreement in effect during this policy period and executed prior to the "occurrence" of the "bodily injury" or "property damage." - B. The insurance provided to the above described additional insured under this endorsement is limited as follows: 1. COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE (Section I - Coverages) only. 2. , The person or organization is only an additional insured with respect to liability arising out of "your work" or "your product" for that additional insured. • 3. In the event that the Limits of Insurance provided by this policy exceed the Limits of Insurance required by the written contract or written agreement, the insurance provided by this endorsement shall be limited to the Limits of Insurance required by the written contract or written agreement. This endorsement shall not increase the Limits of Insurance stated in the Declarations under Item 3. Limits of Insurance pertaining to the coverage provided herein. 4. The insurance provided to such an additional insured does not apply to "bodily injury" or "property damage" arising out of an architect's, engineer's or surveyor's rendering of or failure to render any professional services including: i The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders, or drawings and specifications; and ii Supervisory, inspection, architectural or engineering activities, 5. This insurance does not apply to "bodily injury" or "property damage" arising out of "your work" or "your product" included in the "products-completed operations hazard" unless you are required to provide such coverage by written contract or written agreement. 6. Any coverage provided,by this endorsement to an additional insured shall be excess over any other valid and collectible insurance available to the additional insured whether primary, excess, contingent or on any other basis unless a written contract or written agreement specifically requires that this insurance apply on a primary and non-contributory basis. Manuscript Form Page 1 of 2 Page 4 of 7— C2W2SWPE • 'C. In accordance with the terms and conditions of the policy and as more fully explained in the policy, as soon as practicable, each additional insured must give us prompt notice of any "occurrence" which may result in a claim, forward all legal papers to us, cooperate in the a defense of any actions, and otherwise comply with'all of the policy's terms and conditions. All other terms and conditions of the policy remain the same. ( Authorized Representative • • • Manuscript Form Page 2 of 2 Page 5 of 7 ' C2W2SWPE _ 1 , ENDORSEMENT#038 This endorsements effective 12:0.1 AM Forms a part of policy no.: .013136094 issued'to:' ALTEC, INC: ATTN: MARK.BERTOVIC By: LEXINGTON INSURANCE COMPANY ADVICE OF CANCELLATION TO ENTITIES OTHER THAN THE NAMED INSURED LIMITED TO E-MAIL NOTIFICATION This policy is amended as.follows:. in the event that the Insurer cancels this policy for any reason other than non payment of.premium, and 1. The cancellation effective date is prior to this policy's expiration date; 2. The First 'Named Insured is under an existing' contractual obligation to ;notify a certificate' holder when this policy is canceled (hereinafter, the "Certificate Holderlsl"); and`has provided to the Insurer, either directly or through Its broker of record, the email address of the.contact at such entity, and the Insurer received this information after the First Named Insured receives notice of cancellation of. this policy and prior to this;policy's cancellation, effective dote, via an electronic. spreadsheet that is acceptable to the Insurer, the Insurer will provide advice Of'cancellation'(the'"Advice") via e-mail to such Certificate Holders. Proof of the Insurer emailing the Advice, using the information provided by the First Named Insured; will serve as proof that the Insurer has fully satisfied its'.obligations under this endorsement. This endorsement does not affect, in any way, coverage provided under this policy or the cancellation of this policy or the effective date thereof, nor shall this endorsement Invest any rights in any entity not_ Insured under this policy. - The,following Definitions apply to this.endorsement: 1. First Named Insured means the.Named Insured shown on the,Declarations Page of this policy. 2. Insurer means the insurance; company shown in :the header on the Declarations Pageof this policy. All other terms and conditions remain-unchanged. 9 gt41.4514°.' - Authorized Representative OR Countersignature fin stateswhere applicable) LEXD00O2'1 LX0404 Page 6 of 7 C2W2SWPE Altec, Inc. Policy No. 21WNS27900 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S) This policy is subject, to the following additional on file with the agent of record will be sufficient Conditions: proof of notice. If this policy is cancelled by the Company, other Any notification rights provided by this than for nonpayment of premium, notice of such endorsement apply only to active certificate cancellation will be provided to the certificate holder(s) who were issued a certificate of holder(s) with mailing addresses on file with the insurance applicable to this policy's term. agent of record. Such notice will be provided Failure to provide such notice to the certificate within 30 days of the Company's receipt of holder(s) will not amend or extend the date the certificate holder(s) information from-the agent of cancellation becomes effective, nor will it negate record. cancellation of the policy. Failure to send notice If notice is mailed, proof of mailing to the last shall impose no liability of any kind upon the known mailing address of the certificate holder(s) Company or its agents or representatives. • Form IH 0310 06 11 Page 1 of 1 © 2011,The Hartford Page 7 of 7 C2W2SWPE