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HomeMy WebLinkAboutInsurance Certificate: Control Systems NW LLC ACORD 0 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 07/07/2021 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 Jona Bolin ' NA Sammamish Insurance,Inc. PHONE (425 898-8780 FAX ((A1C No.Ext): (A/C,No): (425)836-2865 704 228th Ave NE,PMB 373 EL JonaBolin@msn.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# • Sammamish WA 98074 INSURER A: Ohio Security Insurance Company 24082 INSURED INSURER B: The Ohio Casualty Insurance Company 24074 Control Systems NW,LLC INSURER c: Continental Casualty Company 20443 dba RH2 Control Systems NW INSURER D: 22722 29th Dr.SE,Ste 210 INSURER E: Bothell WA.98021 INSURER F: COVERAGES CERTIFICATE NUMBER: CL217703789 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. ADDL BR LTR TYPE OF INSURANCE NSD WVD POLICY NUMBER POLICY EFF , POLICY EXP (MMIDDIYYYI� (MMIDDIYYYY) -LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 D10 HENIED CLAIMS-MADE n.00CUR PREMISES(Ea occurrence) $ 1,000,000 MED EXP(Any one person) _$ 15;000 A Y BLS59861156 07/10/2021 07/10/2022 _pERSONALBADVINJURY $ 1:000,000 GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY n JEC n LOC PRODUCTS-COMP/OP AGG $ 2.000,000 OTHER: Stop Gap-WA $ 1,000,000' • AUTOMOBILE LIABILITY COMBINED SINGLE.LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ' A OWNED SCHEDULED Y BAS59861156 07/10/2021 07/10/2022 BODILY INJURY(Per accident) . $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY (Per accident) $ X UMBRELLA LIAB X OCCUREACH OCCURRENCE $ 2,000,000, B EXCESS LIAB CLAIMS-MADE Y US059861156 07/10/2021 07/10/2022 AGGREGATE $ 2,000,000 DED X RETENTION$ 10,000 / $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/NSTATUTE ER A ANY PROPRIETOR/PARTNER/EXECUTIVEri NIA XWS59861156 07/10/2021 07/10/2022 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? 500,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE- $ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Per Claim $2,000,000, Professional Liability C MCH591931734 07/12/2021 07/12/2022 Aggregate $2,000,000 Deductible $ 5,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) The City of Ashland,Oregon and its officials officers arid employees are named as additionalinsured.Coverage is Primary and Non-Contributory as respects General Liability,Automobile Liability and Umbrella Liability. . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main Street AUTHORIZED REPRESENTATIVE Ashland OR 97520 ....,V I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD