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HomeMy WebLinkAbout Insurance Certificate: Osmose Utilities Services Inc AC.�® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 06I18I2021 I 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 d 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). c co PRODUCER CONTACT II NAME: Aon Risk Services Central, Inc. WORE (866) FAX Columbia Center II (A/C.No.Ext): 283-7122 (A!C No): (800) 363-0105 .01 101 West Big Beaver Road EMAIL p 14th Floor/Suite 1444 ADDRESS: _ Troy MI 48084 USA INSURER(S)AFFORDING COVERAGE NAIL# INSURED INSURER A: Old Republic Insurance Company 24147 • Osmose Utilities Services, Inc. INSURERS: Starr Indemnity & Liability Company 38318 635 Highway.74S • - Peachtree City GA 30269 USA INSURER C: INSURER D: INSURER E: 1 INSURER F: COVERAGES CERTIFICATE NUMBER:570087911712 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. Limits shown are as requested INSR ADDL SURF- POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) IMM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY MwzY31489421 07/01/2021'07/01/2022 EACH OCCURRENCE $2,000,000 • CLAIMS-MADE X❑OCCUR DAMAGE TO REN ICD $2,000,000 ' PREMISES(Ea occurrence) MED EXP(Any one person) $5,000 — PERSONAL&ADV INJURY $2,000,000 r GGEEN'LAGGREGATELIMITAPPLIESPER: GENERAL AGGREGATE $4,000,000 POLICY I 1JECT .LOC PRODUCTS-COMP/OPAGG $4,000,000 co o OTHER: A MWTB31562021 07/01/202107/01/2022 COMBINED SINGLE LIMIT `n AUTOMOBILE LIABILITY $5,000,000 (Ea accident) ,• X ANY AUTO BODILY INJURY(Per person) o _ Z OWNED —SCHEDULED BODILY INJURY(Per accident) d) — AUTOS ONLY AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE Per accident) c- -ONLY —AUTOS ONLY � ( :"" 41) B UMBRELLA LIAB X OCCUR 1000095518211 07/01/2021 07/01/2022 EACH OCCURRENCE $10,000,000 V X EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 DED RETENTION A WORKERS COMPENSATION AND MWC31561921 07/01/2021 07/01/2022X PER STATUTE OTH- EMPLOYERS'LIABILITY YIN ER ANY PROPRIETOR/PARTNER/EXECUTIVE El E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NM--- -- - E.L.DISEASE•EA EMPLOYEE _ 11,00Q,000 It yes,describe under DESRIPTION OF OPERATIONS below • E.L.DISEASE-POLICY LIMIT $1,000,000-- MI I 2IEIS DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) The city of Ashland, Oregon, and its elected officials, officers and employees is included as Additional Insured in accordance - with the policy provisions of the General Liability & Automobile Liability policies. The General Liabilityinsurance is primary and non-contributory over any existing insurance and limited to liability arising out of the operations of the named insured subject to policy terms and conditions and where required by written contract. A waiver of subrogation is granted in 1=: favor of Certificate Holder in accordance with the policy provisions of the General Liability policy. W 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. City of Ashland AUTHORIZED REPRESENTATIVE E 20 East Main Street Ashland OR 97520 USA �. W � M gni ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) ' The ACORD name and logo are registered marks of ACORD MSC#17755 Aon Risk Services PO Box 1447 Lincolnshire, IL 60069 MDG2021 00004134 01 i'il111li"l1il'11 .11111,111 ill'ill'lll'IIIiiiii lllllll'rilli City of Ashland ,� 20 East Main Street Ashland OR 97520 • a N o 0 O 0