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HomeMy WebLinkAboutInsurance Certificate: AUMA Actuators Inc (2) ® AcoRD CERTIFICATE OF LIABILITY INSURANCE ,DATE(MM/DD/YYYY) �i �z/zo/zo2z 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 Josh Miller Arthur J.Gallagher Risk Management Services Inc,. PHONE {Ax 1 Pasquerilla Plaza, ' (A/c:No.Extl.412-209-4428 ' NC.No):814-536-5554 Suite 100 . ADDRESS: josh millerl@ajg.com Johnstown PA 15901 • 'INSURER(S)AFFORDING COVERAGE NAIC# , INSURER A:`HDI-Global Insurance Company 41343' INSURED -- • - AUMAACT-02 INSURER B:Travelers Indemnity Company .25658 AUMA Actuators, Inc. 100 Southpointe Boulevard - -'" 'INSURER C:Travelers:Indemnity Co of America , 25666 Canonsburg PA 15317 INSURER D: INSURER.F:`.... '.' - COVERAGES CERTJFICATE NUMBER:1525554895 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 SUER _ .- •.• POLICY EFF POLICY EXP LTR TYPE OF INSURANCE••_.- ..:INSD WVD - POLICY NUMBER (MM/DD/YYYY)'-(MM/DD/YYYY) - _ LIMITS` , A X COMMERCIAL GENERAL LIABILITY •Y GLD1066915 • -„1/1/2023 '_ 1/1/2024 EACH OCCURRENCE $1,000,000 DAMAGE 70 RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $100,000 MED EXP(Any one person) - $5,000 INJURY GEN'L AGGREGATE LIMIT APPLIES PERAGGREGATE GENERAL $2,000,000 PRO- X POLICY' /ECT I I LOC PRODUCTS-COMP/OP AGG $1,000;000 B AUTOMOBILE LIABILITY. Y • BA9N7472672114G 12/31/2022.'. 12/31/2023' Ea accidentSING $1,000;000 LE LIMIT X ANY AUTO • BODILY INJURY(Per person) $. X OWNED SCHEDULEDBODILY•INJURY(Peraccident) $ AUTOS ONLY AUTOS • X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _.AUTOS ONLY (Per accident) A X UMBRELLA LIAB,, X OCCUR•: CUD1067015 1/1/2023 1/1/2024 ” EACH OCCURRENCE $4;000,000 EXCESS LIAB CLAIMS-MADE - AGGREGATE $4,000,000 DED X :RETENTION$in Ann $ C WORKERS COMPENSATION UB9S952683 . 12/31/2022 12/31/2023, X STATUTE- ERH ' AND EMPLOYERS'LIABILITY Y/N • ANYPROPRIETOR/PARTNER/EXECUTIVE. N ."N/A` - - E.L.EACH ACCIDENT $1,000,000. OFFICER/MEMBEREXCLUDED? - (Mandatory in NH) ' , El.DISEASE-EA EMPLOYEE "$1,000,000 If yes,describeunder - " DESCRIPTION OF OPERATIONS below•. - E,L.DISEASE-POLICY LIMIT- $1,000,000 - The City NOAshland,PERONS/LOCATIONS/ CA IONS/VEHICLES EHIL (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) .' ty' g agentsand 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 0001,. edition 04/13.The Workers Compensation policy is Evidence of Coverage 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 East Main Street - _ AUTHORIZED REPRESENTATIVE, - Ashland OR 97520 2 ©1988=2015ACORD CORPORATION: All rights reserved:. ACORD 25(2016/03) ` ; The ACORD name and logo are registered marks of ACORD Arthur J. Gallagher Risk Management Services, Inc. 1 Pasquerilla Plaza, Suite 100 Johnstown PA 15901 MDG2022 0001108601.. • 11111111111111111"11111111111111111111111111111111M11111111111 • City of Ashland 20 EastMainStreet Ashland, OR 97520 We are providing you with a Certificate,of Insurance confirming our client's coverage: Want to get certificatesof 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 thata certificate of insurance is no longer required; or 2. 'E-mail address to send futuref:certificates of insurance in lieu of:U.S. Mail delivery. 3. Insured Code: AUMAACT-02 4. This Certificate-Number:.1525554895 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/. POLICY NUMBER GLD1066915 COMMERCIAL GENERAL LIABILITY CG 20 1.0 0413 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 _ El 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;o c_121Mftte this Schedule,ifnot shown above, mil be shown in the Declarations. 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"I n u or damage" or "personal and advertising. 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- on behalf.of, the additional insured(s) at-the ' in the performance.of , e e e ei Co:ration fir.- location of the covered operations' has been the additional insured(s) at thee location(s) designated above.'' completed;or However 2. That portion of "yourwork" 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 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 the same 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 1of 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 applicable 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 bythe contract or agreement; or • • • Page 2 of 2 ©Insurance Services Office,Inc.,2012 CG 2010 0413 . POLICY NUMBER;'GLD1066915 ! COMMERCIAL GENERAL LIABILITY CG 20 370443 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 o u U e®i\ : s71� @l' `ln.l',at�J mai-Tv Eerr * * SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations ANY PERSON OR ORGANIZATION ANYLOCATION WHERE REQUIRED , WHERE REQUIRED BY WRITTEN BY 'WRITTEN CONTRACT CONTRACT - Information,required to complete this Schedule,If not shown above,will be shown in the Declarations. 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 I11=Limits Of Insurance:, with respect`to -liability for "bodily ;injury" or� ` ' If coverage provided to the additional insured is "property damage"caused, in whole or in part, by required by a contract or agreement, the most we: "your work" at the location -designated: and will pay on behalf of the additional insured is the ' described in the Schedule of"this endorsement amount of insurance: performed for that additional insuredand. ., included in the "products-completed operations 1. Required by 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 requiredby a contract or agreement, the insurance afforded to such,additional insured' will not be broader than.that which you are required by the contractor agreement to " provide for such additional insured: ;t:. CG 20 37 0413 ©Insurance Services Office',Inc.,2012'. Page 1 of 1 • • • 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 broadens coverage:However,coverage for any injury, damage or medical expenses described..in any of the provisions of this endorsementmay 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 covered: A. BROAD FORM NAMED INSURED H. .HIRED AUTO PHYSICAL DAMAGE LOSS OF B. BLANKET' ADDITIONAL INSURED USE INCREASED LIMIT .. C. EMPLOYEE'HIRED AUTO I. PHYSICAL DAMAGE - ;;TRANSPORTATION EXPENSES—INCREASED LIMIT ' D. EMPLOYEES AS INSURED J. PERSONAL PROPERTY ` E. SUPPLEMENTARY PAYMENTS INCREASED LIMITS �K. AIRBAGS 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 Is person or organization qualifies as an "insured" An Insured,of SECTION II—COVERED AUTOS. underInsured:provision contained the Who Is'An LIABILITY COVERAGE: - in Section II, Any organization you newly acquire or form dur C. .EMPLOYEE'HIRED AUTO Any ing the policy periodover which, you maintain • 1. The following is added to Paragraph A.1., 50% or more'ownership interest and that is.not Who Is An Insured,:of.SECTION II — COV- separately insured for Business Auto,Coverage. EKED AUTOS LIABILITY�COVERAGE: Coverage under this provision isafforded only un- An "employee" of yours is an'"insured" while til the 180th day after you acquire-or form the or _operating.an "auto"...hired or,rented under:a ganization or theend of the policy period, which- contract or agreement in an :"employee's" ever is earlier: name;with your permission, while performing duties related.to the conduct of your'busi- ,B. BLANKET'ADDITIONAL:INSURED ness. The following `is'added to Paragraph c, in A.1. 2. .The following replaces,Paragraph b. in B.5., Who Is Ari Insured, of SECTION II COVERED Other Insurance; of SECTION IV - BUSI- AUTOS .. LIABILITY COVERAGE:: NESS AUTO CONDITIONS Any person or organization who is required under b, For Hired Auto Physical Damage Cover- • a written contract or agreement betweenyou and age, the following are deemed to be coy- that 'person or organization, that.is:signed and eyed'"autos':-;you own: executed by you before the "bodily injury" or (1) Any covered "aute you lease, hire,., "property_ertdamage" occurs and:that is in effect, rent or borrow;and during the policy period, tobe 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 which an. "employee's" name,:. with your dama • - -. CA T3 53 02 15 ©2015 The Travelers Indemnity company:All rights reserved. Page"1 of 4 Includes copyrighted material of.Insurance Services Office,Inc:with Its permission: