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HomeMy WebLinkAboutInsurance Certificate: Control Systems NW LLC (2) ACC) CERTIFICATE-OF•LIABILITY INSURANCE . DATE(MM/DD"Y,') 05/26/2020 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. " 1 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 • NAME: - -- . • . Sammamish Insurance,Inc: (A. . PHONE.IC.No.Ext): (4,25)"898=8780 FAX (425)836-2865 (A/C,No):. . . . 704 228th Ave NE,PMB 373 E-MAIL. JonaBolin@msn.com • ADDRESS:ESS_: _ _ • - _ ., INSURER(S)AFFORDING COVERAGE " NAIC#. Sammamish . WA 98074 • INSURERA: Ohio Security Insurance Company 24082' INSURED " . " " INSURER B i 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 21 O.” INSURER E f. Bothell • 'WA 98021 -INSURER F": -, ' ' • . . COVERAGES • . " ' CERTIFICATE NUMBER: 'CL2052603641• • " REVISION NUMBER:" " - • THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO•THEINSURED 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•INSURANCEAFFORDED 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 UBR : I POLICY,EFF POLICY EXP • . LTR TYPE OF INSURANCE . . INSD WVD POLICY NUMBER " I(MM/DD/YYYY) •(MM/DD/YYYY) - LIMITS • -. . . ' - X COMMERCIAL GENERAL LIABILITY . , . I . `' • EACH OCCURRENCE $ 1,000,000 , • ' DAMAGE TO RENTED 1 000,000 CLAIMS-MADE 'X OCCUR _ I . PREMISES(Ea occurrence) $ . ' " " MED EXP(Any one person) $:15,000 A Y' BLS59861156'" - 07/10/2020 07/10/2021 • PERSONAL INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER:R . I GENERALAGGREGATE $ 2,000,000 POLICY"n jEC LOC • PRODUCTS-COMP/OPAGG $ 2.000,000', - 'OTHER: Stop Gap" $ 1,000,000 AUTOMOBILE LIABILITY _ .. . . ..COMBINED SINGLE LIMIT'. $-'1,000,000- ' " ANY AUTO - • ' • ' BODILYdINJURY(Per person)' ' $ ' •A OWNED SCHEDULED Y BAS59861156' 07/10/ 020 07/10/2021. BODILY INJURY(Per accident) $ • AUTOS ONLY AUTOS ' HIRED NON-OWNED - . . i • PROPERTY DAMAGE X AUTOS ONLY" . X AUTOS ONLY " " • . I • : (Per accident) • $ . . . . . . . . . . . . . . . . . $: . . . . X UMBRELLA LIAR. , - OCCUR - • i1 EACH OCCURRENCE $ 2,000,000 • B '' EXCESS LIAB CLAIMS-MADE Y ' US059861156 - 07/10/2020 07/10/2021 AGGREGATE $ 2,000000 DED 'X RETENTION$ 10,000 $ • . . WORKERS COMPENSATION PER ,0TH- - AND EMPLOYERS'LIABILITY: . ' STATUTE ' ER. ANY PROPRIETOR/PARTNER/EXECUTIVE- Y/N - - ,, EL.EACH ACCIDENT-, _ "- ,$-500,000 A" OFFICER/MEMBER EXCLUDED? n N/A XWS596611'S6 .. 07/10/2020 07/10/2021 - - - -- _ - -- (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 • If yes,describe.under•. - . 500,000 DESCRIPTION OF OPERATIONS below _ _ _ E.L.DISEASE-POLICY LIMIT $ • ' • . �. - ' Each Claim . ' $2,000,000.- Professional Liability C• MCH591931734. • 07/12/2019 ,'07/12/2020' Aggregate -$2,000,000 - . Deductible 00 " S. 50, DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more spade is required) • The City of Ashland,Oregon and its officials officers and employees are named as additional insured.Coverage is Primary and Non-Contributory;as . • . respects General Liability,Automobile Liability and Umbrella Liability: I' • • .is . . • • CERTIFICATE HOLDER" . ' . ' ' ' CANCELLATION • ' " . 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. - 20 East Main Street AUTHORIZED REPRESENTATIVE . Ashland OR 97520. ( 4-l""ll I ©1988-2015 ACORD CORPORATION. All rights reserved. wi.esr.e.Ole rnnwerne* Thn Arrnon noma.nnel Innn Ara ranistared marks of ACORD - - • - " • - --