HomeMy WebLinkAboutInsurance Certificate: Kaylor Electric LLC '4 CERTIFICATE OF LIABILITY INSURANCE �"��922'
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(les) 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).
1 PRODUCER CONTACT
FEDERATED MUTUAL INSURANCE COMPANY NAME: CLIENT CONTACT CENTER
PHONE HOME OFFICE:P.O.BOX 328 (A/C, Er
,No, tl:888-333-4949 (FAX,No):507-446-4664
OWATONNA,MN 55060 ADDRESS:CLI ENTCONTACTCENTER(aI.FEDINS.COM
INSURERS)AFFORDING COVERAGE NAIC#
INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935
INSURED 343-086-5 INSURER B:FEDERATED SERVICE INSURANCE COMPANY 28304
KAYLOR ELECTRIC LLC INSURER C:
PO BOX 639
PHOENIX,OR 97535-0639 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:13 REVISION NUMBER:0
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
LTR INSR WVD POUCY NUMBER IMMIDDIVYYYI (MMIDDIYYYY) LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000
CLAIMS-MADE n OCCUR DAMAGE TO RENTED $100,000
PREMISES(Ea occurrence)
X BUSINESS OWNER'S LIABILITY MED EXP(Any one person)
A N N 9118896 07/01/2021 07/01/2022 PERSONALS ADV INJURY $1,000,000
GE
'L AGGREGATEILIMIT APPLIES PER; GENERAL AGGREGATE $2,000,000
_IIX POLICY I 1 ECT LOC PRODUCTS-COMP/OP AGO $2,000,000
OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000
X ANY AUTO
_ BODILY INJURY(Per person)
B —OWNED AUTOS ONLY _
B SCHEDN N 9118897 07/01/2021 07/01/2022 BODILY INJURY(Per accident)
HIRED AUTOS ONLY NON-OWNED AUTOS ONLY PROPERTY DAMAGE
(Per accident)
UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE AGGREGATE
DED I RETENTION .
WORKERS COMPENSATION PER STATUTE OTH-
ER
AND EMPLOYERS'LIABILITY Y/N
ANY PROPRIETORIPARTNERIEXECUTIVE I I E.L.EACH ACCIDENT •
OFFICER/MEMBER EXCLUDED? I IN/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE
It yes,describe under • E.L DISEASE-POLICY LIMIT
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space is required)
CERTIFICATEHOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE
CONDITIONS OF THE ADDITIONAL INSURED BY CONTRACT ENDORSEMENT
FOR BUSINESSOWNERS LIABILITY.
CERTIFICATE HOLDER CANCELLATION
343-086-5 13 0
CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
20 E MAIN ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ASHLAND,OR 97520-1814 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE l/` /1G
Al
O 1988-2015 ACORD CORPORATION.All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD