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HomeMy WebLinkAboutInsurance Certificate : Osmose Utilities Services Inc CO® DATE(MM/DD/YYYY) ACCORD 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 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: rass Corporate Pkwy, PHONE FAX 1560 Saw g rp Suite 300 (A/C.No.Ext►: ' (A/C.No): Sunrise,FL 33323 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# " CN101742660-GAWU-20-21 INSURER A:Old Republic Insurance Co 24147 IN Osmose Utilities Services,Inc. INSURER B:NIA' • N/A 635 Highway 74 South INSURER C:National Fire&Marine Insurance Co 20079 Peachtree City,GA 30269INSURER D:WA N/A " INSURER E:Navigators Insurance Company 42307 INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-004783025-08 REVISION NUMBER: 2 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. b•..-• 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 MWZY314894,20 07/01/2020 07/01/2021 EACH OCCURRENCE $ " 2,000,000 , DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES Ea occurrence) $ 2,000,000 • MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: • GENERAL AGGREGATE $ 4,000,000 X POLICY PLOC PRODUCTS-COMP/OP AGG $ 4,000,000 JECROT OTHER: $ A AUTOMOBILE LIABILITY MWTB 315620 20 • 07/01/2020 07/01/2021 COaMawiBINdenqED SINGLE LIMIT . $ 2,000,000 (E X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULEDBODILY INJURY(Per accident) $ AUTOS ONLY AUTOS , HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ E X UMBRELLA LIAB X OCCUR . NY20EXC9395041V 07/01/2020 07/01/2021 EACH OCCURRENCE $ 5,000,000 C X EXCESS UAB CLAIMS,MADE 42-XSF-302666-05 07/01/2020 07/01/2021 AGGREGATE $ • 5,000,000 X DED RETENTION$ $ A WORKERS COMPENSATION MWC 315619 20 07/01/2020 07/01/2021 X SEATUTE ETH AND EMPLOYERS'LIABILITY1,000,000 ANYPROPRIETOR/PARTNER/EXECUTIVE 1 N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ` I 1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 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) The City of Ashland,Oregon,and its elected officials,officers and employees is/are included as Additional Insured where required by written contract with respect to General Uability and Auto Liability. The General Uability insurance is primary and non-contributory over any existing insurance and limited to liability arising out of the operations of the named insured subject to policy terms and conditions and where required by written contract. Waiver of subrogation is applicable where required by written contract and subject to policy terms and conditigns. , 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 of Marsh USA Inc. • I Sandi Lee • ei a,... e-i-.- ► , ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD IL 10 (12/00) OLD REPUBLICINSLIRANCE CORIPPANY THIS ENOORSEIVIEIsIT CHANGES THE:POLICY. PLEASE REM?.IT CAREFULLY. NOTICEOF CANCELLATION TO CERTIFICATE:HOLDERS. This endorsement modifies the notice of cancellation of Insurance provided hereunder by adding the. following: A. In the event this policyis cancelled for any permissible reason, other than for nonpayment of premium, we shall endeavor to provide advance written notice of cancellation to:certificate holders set out in the schedule on file with the Company;after notifying thefirat.Named Insured of ; such cancellation. Notice of cancellation to holders may be made by any commercially reasonable means,including mad,electronic mail,facsimile transmission or courier 5011fiCe. B. This advance written notification of a cancellation of coverage Is intended as courtesy only.Our failure to provide such advancewrittennotification will not extend thepolicy.cancallationdate, nor negate cancellation of the policy.. All other terms andoonditions Of this policy remain unchanged. PIL 029 10•10 MWIB 31502020 Oarrius6 Uthiljes.Undoes,' 0710112020-.07101/2021 r 1 IL 10 (12/04 OLD..REPUBLIC INSIU.RANCE:.COMpANy THIS ENDoiii4g iE:NT giimpES THE,:PC ppy. PLEAWE REAP iT c.413EFyi.Ly. NOTICE OF CANCELL.ATION TO CERTIFICATE.HCLPERS: This endorsement 2modifies the notice of:cancellation of Insurance provided-hereunder bby adding the following° :Av Inthe event.this policy is.cancelled:for any permissible reason, other than for nonpayment of premium; we shall endeavor to provide. advance written notice of`cancellation to certificate: holders:set out in the:schedule on f►le:with the Company,after notifynotifying the first Named:Insured of . such cancellation:Notice of cancellation to certificate.holders-May be-made by any commercially< reasonablemeeans,including mail,electronic facsimile transmission•or:courier`serum: EL This advance•.written notfication of a cancellation of coverage Is;intended as a courtesy oniy..Our failure to:provide such advance.written inotilicationwill.not extend the policy cancellation date; nor negate`.canceliaitien of.the'poticy All other terms and,conditions of this poticy..remain:unchanged . r PIL 0291010 MWZY314894;20 Osmose:Uhlih o Sorvit.° ;';Inc 07101P2020.-:0770112021 • OLD REPUBLIC INSURANCE COMPANY WORKERSCOMPENSATION AND EMPLOYERS!LIABILITY POLICY NOTICE OF CANCELATION TO CERTIFICATE;HOLDERS ENDORSEMENT This endorsement modifies the notice`of cancelation of insurance provided hereunder by adding the. following: A. In the event this policy is canceled for any permissible reason, other than"for nonpayment of premium,we shall endeavor to provide advance written notice of cancelation to certificate holders set out in the schedule on file with the Company,atter notifying the Insured first named in item 1 of the Information Page of such cancelation. Notice of cancelation to certificate holders may be 7 7 made by any commercially reasonable means, including mail, electronic mail, facsimile transmission or courier service. S. This advance written notification of a cancelation of coverage is intended as a courtesy only. Our failure to provide such advance'written notification will not extend the policy cancelation date, nor negate cancelation of the policy. All other terms and conditions of this poky remain unchanged. • WC 89 03 64(03/11) Page 1 pf