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HomeMy WebLinkAboutInsurance Certificate: Pape' Machinery Inc ' 7 � ACDATE(MM/DD/YYYY) RD CERTIFICATE OF LIABILITY INSURANCE ATE(MMI 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 MARSH USA INC. NAME: 111 SW COLUMBIA,STE.500 PHONE FAX (AJC.No.Ext1: (NC,No): PORTLAND,OR 97201 E-MAILADDRLSS: Attn:portland.certrequest@marsh.com INSURER(S)AFFORDING COVERAGE NAIC# CN101920226-STND-GAW-21-23 PMACH INSURER A:Old Republic Insurance Company 24147 INSURED INSURER B: PAPE MACHINERY,INC. C/O THE PAPE'GROUP INSURER C: PO BOX 407 EUGENE,OR 97440 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: SEA-003202239-76 REVISION NUMBER: 3 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY MWZY31610221 03/01/2021 03/01/2022 EACH OCCURRENCE $ 5,000,000 CLAIMS-MADE X OCCUR PRTORENTED PREMISES l(Ea occurrence) $ 250,000 X CONTRACTUAL LIAB MED EXP(Any one person) $ 0- X PER PROJECT AGG$IoM(CAP) PERSONAL&ADV INJURY $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 6,000,000 POLICY X jECOT- X LOG PRODUCTS-COMP/OP AGG_ $ 6,000,000 OTHER: $ A AUTOMOBILE LIABILITY MWTB31610121 03/0112021 03/01/2022 COMBINED SINGLE LIMIT $ 5,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ X OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS _ X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) RE: THE CITY OF ASHLAND,OREGON,AND ITS ELECTED OFFICIALS,OFFICERS AND EMPLOYEES ARE INCLUDED AS ADDITIONAL INSUREDS WHEN REQUIRED BY WRITTEN AGREEMENT OR CONTRACT AS RESPECTS TO OPERATIONS OF THE NAMED INSURED. CERTIFICATE HOLDER CANCELLATION CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 EAST MAIN STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ASHLAND,OR 97520 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I • 7/1A42L57,4Tec, ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 0000302 SP 0027 -C01-P00302-I CITY OF ASHLAND 20 EAST MAIN STREET ASHLAND,OR 97520 0027-01-00.0000302-0001-0001306 AGENCY CUSTOMER ID: CN101920226 LOC#: Portland ACCPREP ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED MARSH USA INC. PAPE MACHINERY,INC. 0/0 THE PAPE GROUP POLICY NUMBER PO BOX 407 EUGENE,OR 97440 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers'Compensation-Oregon(continued): Policy#483762(Pape'Material Handling,Inc.) Policy#486875(Pape'Group,Inc.) Policy#730660(Pape'Trucks,Inc.) Policy#731864(Pape'Truck Leasing,Inc.) Policy#938352(Pape'Machinery,Inc.) Policy#524683(Pape'DW,Inc.) Policy#999867(White Butte Ranch,LLC) Insurer:SAIF Corporation Effective Date: 01/01/2022 Expiration Date:01/01/2023 Workers'Compensation Limit:Statutory Employer's Liability Limits:$1,000,000.Bodily Injury by Accident-Each Accident/$1,000,000 Bodily Injury by Disease-Each Employee/$1,000,000 Bodily Injury by Disease- Policy Limit. • ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights I The ACORD name and logo are registered marks of ACORDM." 0027-01-00-0000302-0002.0001307