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HomeMy WebLinkAboutInsurance Certificate: Siskiyou Technology Consultants Inc DBA Acme Computer �"1 ACMECOM-CL CSHEATS ACORifr CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DD/YYYY) 41liam..f 6/28/2021 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 CONTACT NAME: George Petersen Insurance Agency,Inc. PHONE FAX 2920 Bechelli Lane (A/C,No,Ext):(530)244-9400 (A/C,No):(530)244-9444 Redding,CA 96002 aDORIEss:info@gpins.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Hanover American Insurance Company 36064 INSURED INSURER B:Allmerica Financial Benefit 41840 Siskiyou Technology Consultants Inc.DBA: Acme Computer , INSURER C:Massachusetts Bay Insurance Co 22306 DBA: Network one 1512 S.Oregon Street INSURER D:Employers Assurance Company 25402 Yreka,CA 96097 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/YYYY) (MM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE X OCCUR OZFA57151206 3/15/2021 3/15/2022 DAMAGE TO RENTED 300,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ Included GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY Tai LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ X ANY AUTO AWFD76655602 11/30/2020 11/30/2021 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOSBODILYBODILY INJURY(Per accident) $ AUTOS ONLY _ AUUTNOS ONLY Peer accidentDAMAGE $ $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE OZFA57151206 3/15/2021 3/15/2022 AGGREGATE $ 1,000,000 DED RETENTION$ $ C WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY Y/N WDFA665792 7/1/2021 7/1/2022 STATUTE ER 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (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 EIG450944701 3/24/2021 3/24/2022 California 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Rearks Schedule,may be attached if more space Is required) Additional certificate holders: City of Ashland Fire Station 1455 SiskiyoumBlvd Ashland,OR, 97520 and City of Ashland Station 2 1860 Ashland Street Ashland,OR 97520 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 51 Winburn Way . Ashland,OR 97520 . AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD