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HomeMy WebLinkAboutInsurance Certificate: Arbor E&T, LLC ACS® DAT ) CERTIFICATE OF LIABILITY INSURANCE 07/01/2020 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. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.If , d 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). E PRODUCER CONTACT o 13 Aon Risk Services Central, Inc. pPHONEFAX Philadelphia PA Office (NC.No.Ext): (866) 283-7122 (NC.No.): (800) 363-0105 ZS One Liberty Place E-MAIL p 1650 Market street ADDRESS: I Suite Philadelphia 00 ph Philaia PA 19103 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Indian Harbor Insurance Company 36940 Arbor E&T, LLC INSURER S: ACE American Insurance Company 22667 dba ResCare Workforce Services 805 N. Whittington Pkwy INSURER C: Indemnity Insurance co of North America 43575 Louisville KY 40222 USA INSURER D: Endurance American Insurance Company 10641 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570082859218 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. Limits shown are as requested INSR ADDL SUBR POLICY Ei-F POLICY hXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MWDD/YYYY) (MM/DD/YYYY) LIMITS B X COMMERCIAL GENERAL LIABILITY XSLG71452220 ((j)'/01/2O2 07/01/2021 EACH OCCURRENCE $4,000,000 CLAIMS-MADE n OCCUR Excess GL/Prof DAMAGEIORENTED SIR applies per policy terns & conditions PREMISES(Ea occurrence) $3 000,000 X Professional Liability Included MED EXP(Any one person) PERSONAL&ADVINJURY $4,000,000 X Sexual Abuse/Molestation Included GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $6,000,00- F3 1 POLICY ❑PRo- El LOC PRODUCTSJECT -COMP/OPAGG $4,000,000 c0 --{I OTHER: B ISA H25301389 07/01/2020 07/01/2021 COMBINED SINGLE LIMIT `) AUTOMOBILE LUU3ILITY $2,000,000 (Ea accidenfl .. X ANY AUTO BODILY INJURY(Per person) C _ . z OWNED —SCHEDULED BODILY INJURY(Per accident) di AUTOS ONLY _ AUTOS di HIRED AUTOS NON-OWNED PROPERTY DAMAGE V —ONLY _AUTOS ONLY (Per accident) n.. r D UMBRELLALIAB X OCCUR XSC30000119104 07/01/2020 07/01/2021 EACH OCCURRENCE $3,000,000 0 XS Auto & EL Only AGGREGATE $3,000,000 X EXCESS UAB CLAIMS-MADE DED RETENTION C WORKERS COMPENSATION AND WLRC67454583 07/01/2020 07/01/2021 x PER STATUTE OTH- EMPLOYERS'LIABILITY Y/N AOS ER ANY PROPRIETOR/PARTNER/EXECUTIVE [1 E.L.EACH ACCIDENT $2,000,000 OFFICER/MEMBER EXCLUDED? N/A - - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $2,000,000 If yes,descnbe under DESCRIPTION OF OPERATIONS below - E.L DISEASE-POLICY LIMIT $2,000,000— A E&O-MPL-Primary MPP003397810 07/01/2020 07/01/2021 Each Claim $5,000,000 Claims Made Aggregate $5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) coverage applicable to work performed under the National Fish & Wildlife grant. ,.._ B M CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE iN EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. The city of Ashl and AUTHORIZED REPRESENTATIVE 20 East Main Street Ashland OR 97520 USA ae5 W Y Am ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000032784 LOC#: Av ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMED INSURED Aon Risk Services!Central, inc. Arbor E&T, LLC POLICY NUMBER See Certificate Number: 570082859218 CARRIER NAIC CODE See Certificate Number: 570082859218 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Additional coverages workers' compensation Policies - 7/1/2020-7/1/2021 WLRC67454583 (All Other States) - Indemnity Insurance Co. of North America, NAIC #43575; WLRC67454546 (CA/MA) - ACE American Insurance Co., NAIC #22667; SCFC67454625 (WI) - ACE Fire underwriters Insurance Co., NAIC #20702; coy. A - Statutory Coy. B - $2,000,000 Each Accident / $2,000,000 Each Employee (Disease) / $2,000,000 Agg. (Disease) Ohio/Washington Excess Workers' compensation Pol # WCUC67454662 - ACE American Insurance Co., NAIC #22667; Coy. A - Statutory Coy. B - $2,000,000 Each Accident / $2,000,000 Each Employee (Disease) / $2,000,000 Annual Aggregate Retention: $1,100,000 ACORD 101(2008101) ©2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD