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HomeMy WebLinkAboutInsurance Certificate: Potelco,Inc AWRD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) � 5/1/2022 04/15/2021 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. 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 LOCKTON COMPANIES CONTACT 3657 BRIARPARK DRIVE,SUITE 700 PHONE rAx No.Ext): (A/C.No): HOUSTON TX 77042 , i�g E-MAIL 866-260-3538 9 d O") ADDRESS: • INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Old Republic Insurance Company 24147 INSURED POTELCO,INC. INSURERB:ACE Property&Casualty Insurance Co 20699 1364742 A QUANTA SERVICES COMPANY INSURER C: 14103 STEWART RD. INSURER D SUMNER WA 98390 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 12424201 REVISION NUMBER: XXXXXXX 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 SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A x COMMERCIAL GENERAL LIABILITY MWZY 313093 21 05/01/2021 05/01/2022 EACH OCCURRENCE $ 5,000,000 A CLAIMS-MADE OCCUR MWZX 313095 21 05/01/2021 05/01/2022DAMAGETO RENTED $ X PREMISES(Ea occurrence) 1,000,000 MED EXP(Any one person) $ Excluded Y N PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 POLICY JECT LOC PRODUCTS-COMP/OPAGG $ 5,000,000 OTHER: $ A AUTOMOBILE LIABILITY MTB31309221. 05/01/2021 05/01/2022(EaacccdeDSINGLELIMIT W $ 5,000,000 A X ANY AUTO MWZX 313091 21 05/01/2021 05/01/2022 BODILY INJURY(Per person) $ XXXXXXX X AWNED SCHEDULED Y N AUTOS ONLY —AUTOS BODILY INJURY(Per accident) $ XXXXXXX HIRED pAMAGE $ XXXXXXX X AUTOS ONLY y NON-OWNED D AUTOS ONLY (I-er accident) $XXXXXXX B X UMBRELLA LIAB X OCCUR XOO G27972032 006 05/01/2021 05/01/2022 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE N N AGGREGATE $ 5,000,000 DED RETENTION$ $ WORKERS COMPENSATION X STATUTE OTH- ER A AND EMPLOYERS'LIABILITY Y/N MWC31309421 05/01/2021 05/01/2022 $ 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE p N/A N E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? I (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 DEdescribe under SesCRIPTION OF OPERATIONS below_ - _ _ _ E.L.DISEASE-POLICY LIMIT $-1 000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Re:All Operations General Liability And Auto Liability Policies Include The City Of Ashland,Oregon,And Its Elected Officials,Officers And Employees As An Additional Insured When Required By Written Contract But Only As Respects Liability Arising Out Of Named Insured's Work For Additional Insured. 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. 12424201 AUTHORIZED REPRESENTATIVE The City Of Ashland,Oregon Attn:Kari Ann Olson 90 N.Mountain Ave. Ashland OR 97520 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION.All rig is reserved The ACORD name and logo are registered marks of ACORD