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HomeMy WebLinkAboutInsurance Certificate: Olsson Industrial ELectric, Inc. ATE ACCORD® CERTIFICATE OF LIABILITY INSURANCE D05/15/2020D/YYYY) 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 LISA Inc. NAME: 1301 5th Avenue,Suite 1900 PHONE A/C,No,Ext): (A/C,No): Seattle,WA 98101 E-MAIL Attn:seattle.certrequest@marsh.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# CN101923908-NAES-GAWUE-20- _INSURER A:Zurich American Insurance Company 16535 INSURED INSURER B:American Zurich Insurance CO. 40142 Olsson Industrial Electric,Inc. 1180 NW Maple Street,Suite 200 INSURER C:ACE Property And Casualty Ins Co 20699 Issaquah,WA 98027 INSURER D:Berkley Assurance Company INSURER E: INSURER F: . COVERAGES CERTIFICATE NUMBER: SEA-003270810-35 REVISION NUMBER: 4 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 ADDL S LTR TYPE OF INSURANCE NSD WVD, POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY I GL05574116-07 05/20/2020 105/20/2021 EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED 1,000,000 PREMISES(Ea occurrence) $ X SIR$200,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY . $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY JECT PRO LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: $ A AUTOMOBILE LIABILITY BAP9830191-10 05/20/2020 05/20/2021 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) COMP/COLL DED $ 5,000 C X UMBRELLA LIAB X OCCUR XEU G27833238006 05/20/2020 0512012021 1,000,000 EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED X RETENTION$1,000,000 $ B WORKERS COMPENSATION WC5574117-07(AOS) 05/20/2020 05/20/2021 X PER ER( )AND EMPLOYERS'LIABILITY Y/N WC5574118-07 WI 05/20/2020 05/20/2021 STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N N/A — - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ D Professional Liability PCAB-5011697-0520 05/20/2020 05/20/2021 Limit: 2,000,000 SIR:$200,000 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 elected officials,officers and employees are included as additional insured where required by written contract and allowed by law with respect to General Liability,Automobile Liability,and Umbrella Liability. This insurance shall be primary and non-contributory and limited to liability arising out of the operations of the named insured when required by written contract,with respect to Genera Liability,Automobile Liability,and Umbrella Liability. 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. Greg Miller �� l►.�� ,' el 1 ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 0000214 SP 0238 -C01-P00214-1 City of Ashland 20 East Main Street Ashland, OR 97520