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HomeMy WebLinkAboutInsurance Certificate: Arbor E&T LLC DBA Rescare Workforce Services �..4 ® DATE(MM/DD/YYYY) �'�o CERTIFICATE OF LIABILITY INSURANCE 07/05/2021 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 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 PRODUCER CONTACT p Aon Risk Services central, Inc. PHONE FAX Philadelphia PA Office (AIC.No.Ext): (866) 283-7122 (A/C.No.): (800) 363-0105a) ms One Liberty Place E-MAIL p 1650 Market Street ADDRESS: _ Suite 1000 Philadelphia PA 19103 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Indian Harbor Insurance Company 36940 Arbor E&T, LLC INSURER B: ACE American Insurance Company 22667 dba ResCare Workforce Services 805 N. Whittington Pkwy INSURER C: Indemnity Insurance Co of North America 43575 Louisville KY 40222 USA INSURER 0: Endurance American Insurance Company 10641 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570088343971 REVISION NUMBER: E. 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, I EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested I INSR ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY LIMITS B X COMMERCIAL GENERAL LIABILITY XSLG72480879 07/01/2021 07/O1/2022 EACH OCCURRENCE $4,000,000 . Excess GL/Prof \DAMAGE TO RENTED CLAIMS-MADE n OCCUR $3,000,000 SIR applies per policy terms & conditions PREMISES(Ea occurrence) X Professional Liability Included MED EXP(Any one person) X Sexual Abuse/Molestation Included PERSONAL&ADV INJURY $4,000,000 R GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $6,000,000 ci X POLICYPRO- �JECT 1---i LOQ PRODUCTS-COMP/OP AGG $4,000,000 OTHER: coson B AUTOMOBILE LIABILITY ISA H25548711 07/01/2021 07/01/2022 COMBINED SINGLE LIMIT $2,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) C Z OWNED —SCHEDULED BODILY INJURY(Per accident) W AUTOS ONLY — AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE V ONLY AUTOS ONLY (Per accident) :.. D UMBRELLA LIAB X OCCUR XSC30000119105 07/01/202107/01/2022 EACH OCCURRENCE $3,000,000 0 XS Auto & EL only AGGREGATE $3,000,000 X EXCESS LIAB CLAIMS-MADE DED RETENTION C WORKERS COMPENSATION AND WLRC67822705 07/01/2021.07/01/2022 X PER STATUTE OTH- EMPLOYERS'LIABILITY Y/N AOS ER ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $2,000,000 B OFFICER/MEMBER EXCLUDED? N/A WLRC67822663 07/01/202107/01/2022,' ' (Mandatory In NH) CA, E.L.DISEASE-EA EMPLOYEE $2,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $2,000,000— A E&O-MPL-Primary MPP003397811 07/01/2021 07/01/2022•Each Claim $5,000,000 Claims Made Aggregate $5,000,000 V._ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Coverage applicable to work performed under the National Fish & wildlife grant. N N a. CERTIFICATE HOLDER CANCELLATION 2 N SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 3 u EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE o POLICY PROVISIONS. 0 � :• The city of Ashland AUTHORIZED REPRESENTATIVE Sr-; c 20 East Main street Ashland OR 97520 USA a `CJLY r� � `�� i .'Ct_i/GpeCJ� � = o . ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000032784 ® LOC#: A� L7 ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMED INSURED Aon Risk Services Central, Inc. Arbor E&T, LLC POLICY NUMBER See Certificate Number: 570088343971 CARRIER NAIL CODE See Certificate Number: 570088343971 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Additional Coverages workers' Compensation Policies - 7/1/2021 - 7/1/2022 WLRC67822705 (All other States) - Indemnity Insurance Co. of North America, NAIC #43575;. WLRC67822663 (CA) - ACE American Insurance Co., NAIC #22667; SCFC67822742 (WI) - ACE Fire Underwriters Insurance Co., NAIL #20702; Coy. A - Statutory Coy. B - $2,000,000 Each Accident / $2,000,000 Each Employee (Disease) / $2,000,000 Agg. (Disease) ohio/washington Excess workers' Compensation Pol # WCUC67822626 - ACE American Insurance Co., NAIC #22667; Cov. A Statutory Cov. B - $2,000,000 Each Accident / $2,000,000 Each Employee (Disease) / $2,000,000 Annual Aggregate Retention: $1,100,000 ACORD 101(2008/01) ©2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD MSC#17755 Aon Risk Services PO Box 1447 Lincolnshire,IL 60069 MDG2021 00010632 01 ilnl111111111llnli'111111.1liliillinl.l1ll11llill.inln1'il'l EtaThe City of Ashland • 20 East Main Street Ashland OR 97520 a N co 13 O O y1. 1 O r 0 0 8 0 0