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HomeMy WebLinkAboutInsurance Certificate: Liquid Engineering Corp. • �....41 LIQUENG-02 RDYER 4 Rte® CERTIFICATE OF LIABILITY INSURANCE DATE ) 5/31/2023 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 Renee Dyer NAME: Billings Office PHONE Fax PayneWest Insurance,a Marsh McLennan Agency LLC Company (A/c,No,Ext):(406)238-1986 (A/c,No): P.O.Box 30638 ADDRIEss:rdyer@paynewest.com Billings,MT 59107-0638 INSURER(S)AFFORDING COVERAGE NAIL# INSURER A:Starr Surplus Lines Insurance Company -13604 INSURED INSURER B:Starr Indemnity&Liability Company 38318 Liquid Engineering Corporation INSURER C:Montana State Fund 15819 P.O.Box 80230' INSURER D:Zurich American Insurance Company 16535 Billings,MT 59108-0230 INSURER E: 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 (MM/DD/YYYYI (MMIDD/YYYY1 A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 1000067931231 6/1/2023 5/1/2024 DAMAGETORENTED 50,000 X PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X PE X LOC • PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ X ANY AUTO 1000686014231 6/1/2023 5/1/2024 BODILYINJURY(Perperson) $ OWNED SCHEDULED AUTOS ONLY _ AUTOS BODILY INJURY(Per accident) $ AUTOS ONLY NON-OWNEDUUTONPROPERTY DAMAGE (Peraccident) $ $ A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 X EXCESSLIAB CLAIMS-MADE 1000338052231 6/1/2023 5/1/2024 AGGREGATE $ 5,000,000 DED X RETENTION$ 0 $ C WORKERS COMPENSATION X PER 0TH- AND EMPLOYERS'LIABILITY STATUTE ER 034802595 3/31/2023 3/31/2024 1,000,000 OFFICER/MEMBER EXCLUDED?ECUTIVE N N/A E.L.EACH ACCIDENT $ (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 $ D Workers Compensation WC959746711 3/31/2023 3/31/2024 OtherStates SeeBelow 1,000,000 A Commercial General L 1000067931231 • 6/1/2023 5/1/2024 Per Claim/Aggregate 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) *Workers Comp Information for Policy WC959746712 Coverage A States: AK,FL,NY • Coverage A Statutory Employers Liability Limits for Policy WC959746712: Each Accident: $1,000,000/Disease-Each Employee: $1,000,000/Disease-Policy Limit: $1,000,000 Part C Other States Insurance-All States except ND,OH,WA,WY,MT and'those States listed in Part 3 A See next page for additional policy information(if applicable). . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ashland Water Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN p ACCORDANCE WITH THE POLICY PROVISIONS. 90 N.Mountain Avenue Ashland,OR 97520 AUTHORIZED REPRESENTATIVE • I aifjk' ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD