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HomeMy WebLinkAboutInsurance Certificate: Selectron Technologies Inc o .4cDATE /DD,YYYY'CERTIFICATE OF LIABILITY INSURANCE L_--- 1/25/2021 . •. 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. '. -,• . o IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions.or be endorsee-7° 1 . 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 Christina Nash •- "•i NAME: . W.B.Adams Co. PHO AIC No,Ext): (503)644-9945 . FAX ,No): "(503)644 9997:.::, General Insurance E-MAILADDRESS: Corrimerciallz@wbadams.com • 14737 SW Milliken Way INSURER(S)AFFORDING COVERAGE '• NAIC#1-.' Beaverton OR 97003 INSURER A: Sentinel Insurance Company - • 11000 - INSURED INSURER B: Hartford Fire and Its P&C Affiliates • 00914 Selectron Technologies,Inc. " INSURER c: Hartford Accident and Indemnity Company 22357 12323 SW 66th Ave INSURER D: Portland,OR,97223 INSURER E: INSURER F: . -COVERAGES CERTIFICATE NUM I: 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. . • ILTR TYPE OF INSURANCE • AUULCUBK POLICY El•F POLICY IOXP INSD WVD POLICY NUMBER (MM/DDIYYYY) (MMIDDIYYYY) LIMITS • • X COMMERCIAL GENERAL LIABILITY0 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE n OCCUR PREMISES(Ea occu ence)_$ 1,000,000 • MED EXP(Any one person) $ . '10,000 A - 52SBAR09216 01/31/2021 01/31/2022 PERSONAL&ADV INJURY $ , . 4000,000 . GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE _$ '"" 2,000,000. X POLICY n JECT ,n LOC • PRODUCTS-COMP/OP AGG $ - - ""-2;000,000 OTHER: Deductible - $,• 1,000 " AUTOMOBILE LIABIIJTY' ' - " COMBINED SINGLE LIMI I • $ • (Ea accident) •-"1',000,000 x ANY AUTO • • , BODILY INJURY(Per person) $ C OWNED SCHEDULED 52UECPT5600 01/31/2021 01/31/2022 BODILY INJURY(Per accident) $ _AUTOS ONLY AUTOS _ s xHIRED v NON-OWNED ' . PROPER I Y DAMN-3h $ AUTOS ONLY x AUTOS ONLY (Per accident) _ __ _ ' • Comp/Collision $ 500/500 , x UMBRELLA LIAB x OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE 52SBAR09216 01/31/2021 01/31/2022 AGGREGATE $ ' 5,000,000' DED x RETENTION S 10,000 •. Deductible $ 1,000 WORKERS COMPENSATION NbH O I - AND EMPLOYERS'LIABILITY XI STATUTE I X I ER H B OFFICER/MEMBER EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVEANY Y^ N IA 52WBCGI3039 01/31/2021 01/31/2022• E.L.EACH ACCIDENT $ 1,000;000 • {Mandatory In NH) I. I E.L.DISEASE-EA EMPLOYEE $ 1,000,000 ' • E yes,describe under , DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000;000 ' • Data Breach/Cyber Liability • Each Occurrence $2,000,000, A Professional Liability/E&O 52SBAR09216 • 01/31/2021 01/31/2022 Aggregate $2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be'attached If more space Is required) - . CERTIFICATE HOLDER • CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE '• THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. ' 20 E Main.Street • - AUTHORIZED REPRESENTATIVE • • • • 4,4 ✓ i Ashland OR 97520 - . ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD .. POLICY NUMBER: 52 SBA R09216 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - PERSON-ORGANIZATION THE CITY OF ATLANTA 68 MITCHELL ST ATLANTA, GA 30303 CITY OF AMARILLO ATTN: PURCHASING DEPARTMENT P 0 BOX 1971 AMARILLO, TX 79135 CITY OF NOVATO 75 ROWLAND WAY #200 NOVATO, CA 94945-5054 CITY OF OCEANSIDE 300 NORTH COAST HWY OCEANSIDE, CA 92054 CITY OF PORTLAND 1120 SW 5TH AVE ROOM 750 PORTLAND, OR 97204 CITY OF SANTA ANA 20 CIVIC CENTER PLAZA SANTA ANA, CA 92701 COUNTY OF PLACER C/O EBIX BPO P 0 BOX 257 PORTLAND, MI 48875 FULTON COUNTY GOVERNMENT DEPARTMENT OF PURCHASING & CONTRACT COMPLIANCE 130 PEACHTREE STREET SW. SUITE 1168 ATLANTA, GA 30303-3459 PLACER COUNTY WATER AGENCY P 0 BOX 6570 AUBURN, CA 95604 Form IH 12 00 11 85 T SEQ.NO. 003 Printed in U.S.A. Page 001 (CONTINUED ON NEXT PAGE) Process Date: 11/09/20 Expiration Date: 01/31/22 POLICY NUMBER: 52 SBA R09216 sit THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - PERSON-ORGANIZATION THE CITY OF ELK GROVE ITS OFFICIALS, EMPLOYEES, AGENTS, AND VOLUNTEERS PO BOX 20270 LONG BEACH CA 90801 CITY OF DETROIT PURCHASING DIVISION COLEMAN A YOUNG MUNICIPAL CENTER SUITE 1008 DETROIT, MI 48226 CITY OF FRESNO C/O ISD 2600 FRESNO ST., ROOM 1059 FRESNO, CA 93721 CITY OF ASHLAND 20 EAST MAIN STREET ASHLAND, OR 97520 Form IH 12 00 11 85 T SEQ.NO. 003 Printed in U.S.A. Page 002 (CONTINUED ON NEXT PAGE) Process Date: 11/09/20 Expiration Date: 01/31/22 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ°IT.CAREFULLY. NOTICE OF CANCELLATION TO CERTIFICATE:. HOLDER(S) This policy is subject to the following additional Conditions: A. If this policy is cancelled by the Company, other If notice is mailed, proof of mailing to the last known than for non-payment of premium, notice of such mailing address of the certificate holder(s) on file with cancellation will be provided at least thirty (30) days the agent of record or the Company will be sufficient in advance of the cancellation effective date to the proof of notice. certificate holder(s) with mailing addresses on file Any notification rights provided by this endorsement with the agent of record or the Company. apply only to active certificate holder(s)who were issued B. If this policy is cancelled by the company for non- a certificate of insurance applicable to this policy's term. payment of premium, or by the insured, notice of Failure to provide such notice to the certificate holder(s) such cancellation will be provided within ten (10) will not amend or extend the date the cancellation days of the cancellation effective date to the becomes effective, nor will it negate cancellation of the certificate holder(s) with mailing addresses on file policy. Failure to send notice shall impose no liability of with the agent of record or the Company. any kind upon the Company or its agents or representatives. Form SS 12 23 0611 Page 1 of 1 © 2011,The Hartford