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HomeMy WebLinkAboutInsurance Certificate: Metals Treatment Technologies LLC Client#: 33569 METTREPC MM/DD/YYYY) ACORD,�, CERTIFICATE OF LIABILITY INSURANCE DATE 9/20/2021 (( M/DDI 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER ate TACT Nick Brown NE: Holmes Murphy-ColoradoPHONE 720-458-5770 FAX 7600 East Orchard Road Suite 230 South MA Lc Ext): (NC,No): ' ADDRESS: nbrown@holmesmurphy.com Property Casualty-Colorado INSURER(S)AFFORDING COVERAGE NAIC# Greenwood Village,CO 80111 INSURER A:Starr Surplus Lines Insurance Company 13604 INSURED INSURER B:Pinnacol Assurance Company 41190 Metals Treatment Technologies, LLC Zurich American Insurance Company INSURER C: P Y 16535 14045 West 66th Avenue AGCS Marine Insurance Company INSURER D: P Y 22837 Arvada,CO 80004 INSURER E:Starr Indemnity&Liability Company 38318 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. EXP LTR TYPE OF INSURANCE NSR WVADDL D POLICY NUMBER (MM/DDY�) (MM/DDY ) LIMITS A X COMMERCIAL GENERAL LIABILITY X 1000067113202 10/01/2021 10/01/2022 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR PREMISES(Ea RENTED $100,000 X BI/PD Ded:$2,500 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY X JECOT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ E AUTOMOBILE LIABILITY 1000638063202 10/01/2021 10/01/2022 Wa accciden SINGLE LIMIT $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ XAIT OE ONLY XNON-OWNED PROPERTY DAMAGE $ AUTOS ONLY (Per accident) A UMBRELLA LIAB X OCCUR 1000337409202 10/01/2021 10/01/2022 EACH OCCURRENCE $8,000,000 XEXCESS LIAB CLAIMS-MADE AGGREGATE $8,000,000 DED X RETENTION$O $ B WORKERS COMPENSATION 4226286 10/01/2021 10/01/2022 X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L,DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 C Workers'Comp-OSC - WC298299501 10/01/2021 10/01/2022 $1MiI/1MiI/$1MiI- - D L/R Eq/Installat SML93024512 10/01/2021 10/01/2022 $1,000,000;$1,000 Ded A Poll/Prof Liab 1000067113202 10/01/2021 10/01/2022 $1Mil Occ/$2Mil Agg DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project:Ashland Gun Club Trap/Skeet Range As required by written contract or written agreement,the City of Ashland,Oregon,and its elected officials,officers and employees are included as Additional Insured under General Liability and Automobile Liability on a primary and non-contributory basis with respect to the above referenced. CERTIFICATE HOLDER CANCELLATION Cityof Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 E.Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland,OR 97520 AUTHORIZED REPRESENTATIVE 04144111 ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S719911/M719731 MANV1