Loading...
HomeMy WebLinkAboutInsurance Certificate: Control Systems NW LLC 1 • ....-----•1 ACORO® DATE(MM/DD1Y YY) Ate CERTIFICATE OF LIABILITY INSURANCE. 06/30/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NOIRIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDD BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSIJ ER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. I IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)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 - , Sammamish Insurance,Inc. • PHONN Ext): (425)898-8780 I FAX No): (425)836-2865 704 228th Ave NE,,PMB 373 - ' E-MAIL,DDRE - • : JonaBolin@msn.com • 1 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 1 20443 DBA: RH2 Control Systems NWINSURER D: q 22722 29th Dr SE Ste 210 INSURER E: 1 Bothell WA 98021 INSURERF: ; COVERAGES CERTIFICATE NUMBER: -.CL2363004090 REVISION NUMBER: ' .' - THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FO 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 7O 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 (MM/DDIYYYY) (MM/DDIYYYY) . LIMITS COMMERCIAL GENERAL LIABILITY / DAMAGE EI-0 RENTED 1,000,000 X EACH OCCURRENCE $ • CLAIMS-MADE n OCCUR PREMISES(Ea occurrence) $ 1,000,000 •• I MED EXP.,/r(Any one person) $ 15,000 A Y BKS59861156 07/10/2023 07/10/2024 PERSONAL&ADV INJURY $ 1,000,000 • — 2000000 • GEN'LAGGREGATE LIMITAPPLIES PER: •_ GENERA AGGREGATE $ , , POLICY❑X jE8T D LOC • PRODUC S-COMP/OPAGG $ 2,000,000- OTHER: i• Stop Gajp-WA $ $1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident— ) ANY AUTO I • BODILY INJURY(Per person) $ A OWNED SCHEDULED Y BAS59861156 07/10/2023 07/10/2024 BODILY 11�JURY(Per accident) $ AUTOS ONLY AUTOS s HIRED % NON•OWNED I PROPERW DAMAGE $ AUTOS ONLY X AUTOS ONLY 1 (Per acrid et) I g $ X UMBRELLA LIAB — OCCUR EACH OCCURRENCE $ 2,000,000 B EXCESS LIAB CLAIMS MADE USO59861156 07/10/2023 07/10/2024 AGGREG TE $ 2,000,000 DED X RETENTION$ 10,000 1 1 $ WORKERS COMPENSATION PER) OTH- AND EMPLOYERS'LIABILITY - Y/N • STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACI4ACCIDENT $ 1.000,000 A OFFICER/MEMBER EXCLUDED? El /A XWS59861156 07/10/2023 07/10/2024 (Mandatory In NH) E.L.DISEt},SE.EAEMPLOYEI, ,$, 1,0000,000 -.- . if yes.8'e-scfi`be ufider ••'''•_ _ ., — r-'.,4 1,VQO,Oh1'y0 ''y,"'..7'? DESCRIPTION OF OPERATIONS below ...El.DISEASE-POLICY LIMIT $ 1 Per Claire $2,000,000 Professional Liability C Claims Made MCH591931734 07/12/2023 07/12/2024 Aggregate $2,000,000 Deductible $15,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) The City of Ashland,Oregon and its officials officers and employees are named as additional insured automatically where required by ' ntract and coverage I is Primary and Non-Contributory per CG8810 as respects General Liability. Project:Water Filtration Instrumentation&Controls Integrator i 1 CERTIFICATE HOLDER CANCELLATION s SHOULD ANY OF THE ABOVE DESCRIBEDDPOLICIES 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 (,.,,, ! I ©1988-2015 ACORD ORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD I / 1 S AC D® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) LI'''. I 06/30/2023 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(les)must have ADDITIONAL INSURED provisions or,be endorsed. i . If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on ; :I, this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). � PRODUCER CONTACT Jona Bolin - . ' I e Sammamish Insurance,Inc. • PHONE, (425)898-8780 I Fax` (425)836-2865 • • •j (A/C,No;Ext): (AIC,No; 704 228th Ave NE,PMB 373 E-MAIL JoneBolin@msn.com ' • , . ADDRESS: , I •. INSURER(S)AFFORDING COVERAGE ' ' NAIC# . 'p Sammamish WA 98074 INSURER A: Ohio Security Insurance Company 24082. " INSURED INSURER B: The Ohio Casualty Insurance Conpany • 24074 Control Systems NW LLC INSURER c: Continental Casualty Company 1 20443 DBA: RH2 Control Systems NW INSURER D: 1 22722 29th Dr SE Ste 210 INSURER E: Bothell WA 98021 INSURER F: COVERAGES •CERTIFICATE NUMBER:' CL2363004090 , REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THEIINSURED 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 1;O ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1 INSR ADDL bUBR - POLICY EFF POLICY EXP g LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER . (MM/DDIYYYY) (MM/DD/YYYY) 1 LIMITS X COMMERCIAL GENERAL LIABILITY / 1,000,000 EACH OCCURRENCE $ DAMAGE TO RENTED 1,000,000 CLAIMS-MADE OCCUR , PREMISES(Ea occurrence) $ MED EXPIg(Any one person) $ 15,000 A Y BKS59861156 07/10/2023 07/10/2024 PERSONAL&ADVINJURY $ 1,000,000, GEN'L AGGREGATE LIMITAPPLIES PER: GENERALLGGREGATE $ 2,000,000 i POLICY ❑X jEo- LOC -- PRODUCTS $ 2,000,000 " I. `-. OTHER:.. Stop GO-WA $'$1,000,000 . •AUTOMOBILE LIABILITY' ,. COMBINED SINGLE LIMIT $ 1,000,000 • (Ea accident) ANY AUTO - '' - - BODILY IIyJURY(Per person) - $ A OWNED ^SCHEDULED Y BAS59861156 ', • 07/10/2023 07/10/2024 BODILY*CRY(Peraccdent) $ AUTOS ONLY AUTOS _ HIRED NON-OWNED PROPERTY DAMAGE Ne AUTOS ONLY X AUTOS ONLY . (Per accidp�nt) $ II i X UMBRELLALIAB _ OCCUR EACH OCCURRENCE , , $ 2,000,000 1 B EXCESS LIAR CLAIMS-MADE US059861156 07/10/2023 07/10/2024 AGGREGATE $ 2,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION I S-71'4 I 10TH- AND EMPLOYERS'LIABILITY 1 STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 1,000,000 A NIA XWS59861156 07/10/2023 07/10/2024 E.L.EAC ACCIDENT $ j OFFICER/MEMBER EXCLUDED? y (Mandatory In NH) E.L.DISEASE=EA EMPLOYEE $ 1,000,000 ' If yes,describe under 1,0 0,0 000 DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT $ Professional Liability Per Clair $2,000,000 C Claims Made MCH591931734 07/12/2023 07/12/2024 Aggrega a $2,000,000 Deductible $15,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City of Ashland,Oregon and its officials officers and employees are named as additional insured automatically where required by c ntract and coverage is Primary and Non-Contributory as respects General Liability and Automobile Liability. Re:RH2 Contract M211007,Ashland Water Division On-Call SCADA CERTIFICATE HOLDER CANCELLATION I SHOULD ANY OF THE ABOVE DESCRIBEDiPOLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE1WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVIS ONS. 20 East Main Street , ( I Public Works Department AUTHORIZED REPRESENTATIVE Ashland OR 97520 I t ©1988-2015 ACORD'ORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 5 2 1 ^O ) 1 { � ACCP ® DATE(MM/DD/YYYY) ,v` /7�� CERTIFICATE OF LIABILITY INSURANCE 06/30/2023• , 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 INSU'RER(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 I NAME: Sammamish Insurance,Inc. PHONE Ext): (425)898-8780 1 FAX No): (425)836-2865 (A/C,No, 704 228th Ave NE,PMB 373 E-MAIL JonaBolin@msn.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Sammamish WA 98074INSURERA: Ohio Security Insurance Company. 24082 t 1 INSURED INSURER B: The Ohio Casualty Insurance Cgpnpany 24074 Control Systems NW LLC INSURER c: Continental Casualty Company p1p 204431 DBA: RH2 Control Systems NW INSURER D: I 22722 29th Dr SE Ste 210 INSURER E: BE Bothell • WA 98021 INSURER F: I ! V COVERAGES CERTIFICATE NUMBER: CL2363004090 REVISION NUMBER: 1 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD I , 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 ADDL SUBR POLICY EFF POLICY EXP pp LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) 9 LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR DAMAGEpIrORENTED 1,000,000 PREMISES(Ea occurrence) $ I MED EXPI(Any one person) $ 15,000 A Y BKS59861156 07/10/2023 07/10/2024 a 1,000,000 PERSONAL&ADV INJURY $ _ GEN'LAGGREGATE LIMIT APPLIES PER: GENERAIIAGGREGATE $ 2,000,000 POLICY El78: n LOC OTHER: 0000PRODUCTS-COMP/OP AGG $ 2,0 Stop Gp WA $ , AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 t ' _ (Ea accident) ANY AUTO • BODILY EEJURY(Per person) $ A OWNED —SCHEDULED Y BAS59861156 07/10/2023 07/10/2024 BODILY II\JURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPER*DAMAGE X AUTOS ONLY X AUTOS ONLY (Per accident) $ I $ I X UMBRELLALIAB _ OCCUREACH OCCURRENCE $ 2,000,00 • 0 B EXCESS LIAB CLAIMS-MADE USO59861156 07/10/2023 07/10/2024 AGGREGATE $ 2,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION PERI OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACI-I ACCIDENT $ 1,000,000 A OFFICER/ MEMBER EXCLUDED? N IA XI/1IS59861156 07/10/2023 07/10/2024 (Mandatory In NH) E.L.DISEASE -EA EMPLOYEE $ 1,000,000 If yes,describe under p 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Per Clailm $2,000,000 C Professional Liability $2,000,000,MCH591931734 07/12/2023 07/12/2024 A re a}e Claims Made 99 9 Deductible $15,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) i The City of Ashland,Oregon and its officials officers and employees are named as additional insured automatically where required by contract and coverage Ci is Primary and Non-Contributory as respects General Liability and Automobile Liability. 1 Re:RH2 Contract M211006,Ashland WW ITB. 1 CERTIFICATE HOLDER CANCELLATION i 1 I SHOULD ANY OF THE ABOVE DESCRIBEDIPOLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICEWILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main Street AUTHORIZED REPRESENTATIVE g I Public Works Department Ashland OR 97520 PPPP I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 1 s , �, I, AC�oRIJ CERTIFICATE OF LIABILITY INSURANCE DATE(MMI202�) 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. i 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). j PRODUCER CONTACT Jona Bolin 1 NAME: Sammamish Insurance,Inc. PHONE Ext): (425)898-8780 ,i (A/C,No):Ax (425)836-2865 704 228th Ave NE,PMB 373 ADDRIESS: JonaBolin@msn.com I I INSURER(S)AFFORDING COVERAGE . NAIC# I Sammamish WA 98074INSURERA: Ohio Security Insurance Company . 1 24082, '. INSURED INSURER B: The Ohio Casualty Insurance Co4npany 24074 Control Systems NW LLCINSURER C: Continental Casualty Company 1 20443 DBA: RH2 Control Systems NW INSURER D: 1 t1 'f 22722 29th Dr SE Ste 210 INSURER E: I Bothell WA 980211 1 INSURER F COVERAGES CERTIFICATE NUMBER: CL2363004090 i 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. I INSR ADDL SUBR POLICYIEFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POUCY NUMBER (MMIDDIYYYY) (MM/DD/YYYY) I LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE n OCCUR PREM SES(EOE occuE ence) $ 1,000,000 MED EXP{(Any one person) $ 15,000 A Y BKS59861156 07/10/2023 07/10/2024PERSONAL&ADV INJURY_ $ 1.000,000 GGEEN'LAGGREGATE LIMITAPPLIES PER: GENERAIIAGGREGATE $ 2,000,000 jI POLICY n JEC n LOC PRODUCT $ 2.000,000 OTHER: St p-WA $ $1,000,000; AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT _ (Ea accident) $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED Y BAS59861156 07/10/2023 07/10/2024 BODILY INJURY(Per accident) $ _ AUTOS ONLY AUTOS I ,FF Y X AUTOS ONLY HIRED X AUTOS ONLY Perr a c denDAMAGE $ X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,000 B EXCESS LIAB CLAIMS-MADE Y USO59861156 07/10/2023 07/10/2024 AGGREGATE $ 2,000,000 DED X RETENTION$ 10,000 1 $ WORKERS COMPENSATION PERI OTH- AND EMPLOYERS'LIABILITY Y/NSTAT+UTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACI-IACCIDENT $ 1,000,000 A OFFICERIMEMBER EXCLUDED, N IA XWS69661166 07/1012023 07/10/2024 , (Mandatory In NN) E.L.DISEASE-EA EMPLOYEE $ 1,000.000 If yes,describe under • I 1,000,000 DESCRIPTION OF OPERATIONS bolow E.L.DISEASE-POLICY LIMIT $ Professional Liability Per CIali $2,000,000 C MCH591931734 07/12/2023 07/12/2024 Aggrega $2,000;000 Claims Made 99ase 9 Deductible $15,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) I The City of Ashland,Oregon and its officials officers and employees are named as additional insured.Coverage is Primary and Non-Co tributory as respects General Liability,Automobile Liability and Umbrella Liability. CERTIFICATE HOLDER CANCELLATION I I 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. 1 20 East Main Street. AUTHORIZED REPRESENTATIVE Ashland OR 97520 I ' Imo} ©1988-2015 ACORD'CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD I I I