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HomeMy WebLinkAboutInsurance Certificate: Pape Machinery Inc ACO CERTIFICATE OF LIABILITY INSURANCE DATE E5M0/ Duerr) 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 MARSH USA INC. NAME: 111 SW COLUMBIA,STE.500 (A/CNN .Ext):E FAX No): PORTLAND,OR 97201 E-MAILADDRLSS: Attn:Amy Shafer 503-248-4857;amy.shafer@marsh.com INSURER(S)AFFORDING COVERAGE NAIC# CN101920226-STND-GAW-21-22 PMACH INSURER A:Old Republic Insurance Company 24147 INSURED INSURER B:N/A N/A PAPE'MACHINERY,INC. C/O THE PAPE GROUP INSURER C:N/A N/A PO BOX 407 INSURER D: EUGENE,OR 97440 INSURER E: • INSURER F: COVERAGES CERTIFICATE NUMBER: SEA-003202239-73 REVISION NUMBER: 3 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 EFF POLICY EXP/YLIMITS LTRINSD WVD POLICY NUMBER (MM/DDYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY MWZY31610221 03/01/2021 03/01/2022 EACH OCCURRENCE $ 5,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES Ea occurrence) $ 250,000 X CONTRACTUAL LIAB MED EXP(Any one person) $ 0 X PER PROJECT AGG$10M(CAP) PERSONAL 8 ADV INJURY $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 6,000,000 POLICY X JECT X LOC PRODUCTS-COMP/OP AGG $ 6,000,000 OTHER: $ A AUTOMOBILE LIABILITY MWTB31610121 03/01/2021 03/01/2022 COMBINED SINGLE LIMIT $ 5,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ X 1 OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N STATUTE ERH ANYPROPRIETOR/PARTNER/EXECUTIVE 1-1 N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) RE: THE CITY OF ASHLAND,OREGON,AND ITS ELECTED OFFICIALS,OFFICERS AND EMPLOYEES ARE INCLUDED AS ADDITIONAL INSUREDS WHEN REQUIRED BY WRITTEN AGREEMENT OR CONTRACT AS RESPECTS TO OPERATIONS OF THE NAMED INSURED. CERTIFICATE HOLDER CANCELLATION CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 EAST MAIN STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ASHLAND,OR 97520 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Raymond M.Schneider ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 0001545 SP 0094 -C01-P01545-I CITY OF ASHLAND 20 EAST MAIN STREET ASHLAND, OR 97520 fid . 1 '• .f �Fkt 0094-01-00-0001545-0001-0003295 y''} • AGENCY CUSTOMER ID: CN101920226 LOC#: Portland ARD ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED • MARSH USA INC. PAPE'MACHINERY,INC. C/O THE PAPE'GROUP POLICY NUMBER PO BOX 407 • EUGENE,OR 97440 CARRIER NAIC CODE • EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance • Workers'Compensation-Oregon(continued): Policy#483762(Pape'Material Handling,Inc.) Policy#486875(Pape'Group,Inc.) • Policy#730660(Pape'Trucks,Inc.) • . Policy#731864(Pape'Truck Leasing,Inc.) • Policy#938352(Pape'Machinery,Inc.) Policy#524683(Pape'DW,Inc.) Policy#999867(White Butte Ranch,LLC) Insurer:SAIF Corporation • Effective Date: 01/01/2021 Expiration Date:01/01/2022 Workers'Compensation Limit:Statutory Employer's Liability Limits:$1,000,000.Bodily Injury by Accident-Each Accident/$1,000,000 Bodily Injury by Disease-Each Employee/$1,000,000 Bodily Injury by Disease- Policy Limit. • • • • • ACORD 101 (2008/01) ©.2008 ACORD CORPORATION. All rights I The ACORD name and logo are registered marks of ACORD ry 0094.01-00-0001545.0002-0003296 Dear Certificate Holder: As many companies have moved to a remote working environment, mailing Certificates of Insurance to a physical address can cause unnecessary delays in providing you proof of insurance. To streamline delivery and in an effort to support our firm's commitment to sustainability,going forward,we would like to distribute your Certificates of Insurance electronically if possible. We are kindly requesting Certificate Holders provide us an email address where we can deliver your COI in the future. Please send your response to: USOperations.email@marsh.com and provide the following information so that we can expedite your COI delivery: • Certificate ##(Shown below insured Name—e.g.:ABC-123456789-01) a E-Mail for future delivery: For undeliverable email addresses,our system is configured to automatically redirect the Certificate for delivery via USPS. Lastly, if you no longer need this COI please respond to USOperations.email@marsh.com with the Certificate number and we will inactive the record in our system to avoid future automatic delivery. Thank you. US Operations, Marsh USA, Inc.