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HomeMy WebLinkAboutInsurance Certificate: Hydropoint Data Systems / ® DATE(MM/DD/YYYY) ACRO CERTIFICATE OF LIABILITY INSURANCE t`..--- 12/30/2021 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). PRODUCERCONTACT Risk Strategies Company NAME: Lisa Pfitzer 700 AirportBOUIeVard, Suite 300 /q/CNN.Ext): (650)762-0455 talc,No): (650)762-0490 Burlingame, CA 94010 E-MAIL ADDRESS: 1pfitzer@risk-strateqies.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Hartford Accident and Indemnity Company 22357 INSURED INSURER B: Hydropoint Data Systems 1720 Corporate Circle INSURER C: Petaluma CA 94954 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 66043290 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 ANYREQUIREMENT,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 ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDDIYYYY) (MMIDD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY _ AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION 57WECAC5SET 1/1/2022 1/1/2023 ,, PEATUTE ETH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/F�(ECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED? 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 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Waiver of Subrogation applies per form WC000313 CERTIFICATE HOLDER CANCELLATION CI of SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 East Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland OR 97520 AUTHORIZED REPRESENTATIVE I RSC Insurance Brokerage ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 66043290 122-23 WC I Aimee DeMoss 112/30/2021 4:40:52 PM (PST) 1 Page 1 of 3 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT Policy Number:57WECAC5SET Endorsement Number: Effective Date1/1/2022 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: Hydropoint Data Systems 1720 Corporate Circle Petaluma CA 94954 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. SCHEDULE Countersigned by Authorized Representative Form WC 00 03 13 Printed in U.S.A. Process Date: Policy Expiration Date:1/1/2023 66043290 122-23 WC 1 Aimee DeMoss 112/30/2021 4:40:52 PM (PST) 1 Page 2 of 3 -1111111 . Hydropoint Data Systems 4., -41.11*-- TEs INSURANCE POLICY CANCELLATION PROVISIONS The "Common Policy Conditions" section of all commercial insurance policies state that the insurance company will cancel the policy by giving written notice to the "FIRST NAMED INSURED" 10 days before the effective date of cancellation for non-payment of premium and 30 days before the effective date of cancellation for any other reason. Also, the "FIRST NAMED INSURED" has the right to cancel the policy in writing at anytime with no further notice of cancellation. The insurance company does not give notice of cancellation to any other"NAMED INSURED" or to any "ADDITIONAL INSUREDS". Cancellation provisions in a policy cannot be altered by an Insurance Agent because they are part of a legal contract between the Insurance Company and the Insured. Furthermore, policy forms must be approved by the State Department of Insurance. The certificate of insurance on an Acord Form 25 states that the certificate cannot amend, alter, or extend the coverage in the insurance policy. That is why the cancellation provisions on the current insurance certificate state that cancellation "Notice will be delivered in accordance with the policy provisions". The insurance company will not provide you, the ADDITIONAL INSURED, notice of policy cancellation. However, acting in the capacity as the Insured's Agent, we will endeavor to provide you with the 10 days notice of cancellation by the insurance company for non-payment of premium and 30 days notice of cancellation by the insurance company for any other reason. Risk Strategies Company 700 Airport Blvd.,Suite 300 Burlingame,CA 94010 Telephone:(650)762-0400 Fax(650)762-0490 66043290 122-23 WC I Aimee DeMoss 112/30/2021 4:40:52 PM (PST) I Page 3 of 3 Hydropoint Data Systems 1720 Corporate Circle Petaluma,CA 94954 MAIL DOCUMENT Certificate of Insurance Delivery by ecertsonlineTM City of Ashland *1! 0 Aimee DeMoss 20 East Main Street �7 Ashland OR 97520 ��1°' '� Sub ect Cert No.66043290-Renewal Certificate of Liability for:Hydropoint Data Systems 111,91e-,.'7 12/30/2021 No t-o Pages 4 THIS MESSAGE IS INTENDED FOR THE USE OF THE INDIVIDUAL OR ENTITY TO WHICH IT IS ADDRESSED AND MAY CONTAIN INFORMATION THAT IS PRIVILEGED,CONFIDENTIAL AND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW.IF THE READER OF THE MESSAGE IS NOT THE INTENDED RECIPIENT,OR THE EMPLOYEE OR AGENT RESPONSIBLE FOR DELIVERING THE MESSAGE TO THE INTENDED RECIPIENT,YOU ARE HEREBY NOTIFIED THAT ANY DISSEMINATION,DISTRIBUTION OR COPYING OF THIS COMMUNICATION IS STRICTLY PROHIBITED.IF YOU HAVE RECEIVED THIS COMMUNICATION IN ERROR,PLEASE NOTIFY US IMEDIATELY BY TELEPHONE,AND RETURN THE ORIGINAL MESSAGE TO US AT THE ABOVE ADDRESS VIA REGULAR POSTAL SERVICE, Certificate of Insurance Delivered by ecertsonhlneTM Insurance Visions,Inc.All rights reserved.