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HomeMy WebLinkAboutInsurance Certificate: Potelco, Inc 1 V- 1 A�E? CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 5/1/2021 4/14/2020 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 LOCKTON COMPANIES • NNAAMEACT .• . 3657 BRIARPARK DRIVE,SUITE 700 PHONE Ext): (aC,No): HOUSTON TX 77042 E-MAIL , 866-260-3538 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Old Republic Insurance Company 24147 INSURED POTELCO,INC. • INSURER B: ACE Property&Casualty Insurance Co 20699 1364742 A QUANTA SERVICES COMPANY INSURER C: 14103 STEWART RD. SUMNER WA 98390 INSURER D: 1 INSURER E: INSURER F: 1 COVERAGES CERTIFICATE NUMBER: 12424201 I REVISION NUMBER: XXXXXXX 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 SUBR POLICY EFF' POLICY EXP LTR TYPE OF INSURANCE INSD_WVD POLICY NUMBER (MM/DD/YYYYL(MMIDDIYYYY) LIMITS A x COMMERCIAL GENERAL LIABILITY y N MWZY 313093 20 5/1/2020 5/1/2021 EACH OCCURRENCE $ 5,000,000 A CLAIMS-MADE n OCCUR MWZX 313095 20 5/1/2020 5/1/2021 DAMAGE O(Ea RENTED occurrence) $ 1,000,000 1 I MED EXP(Any one person) $ Excluded PERSONAL&ADV INJURY ,$ '1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 IPOLICYnJECT' n LOC' PRODUCTS-COMP/OP AGG $ 5,000,000 OTHER: . . . .- $ A AUTOMOBILE LIABILITY Y N MWTB 313092 20. 5/1/2020 . 5/1/2021 (E0 aac deDn SINGLE LIMIT $ 5 000 000 A • MWZX 313091 20 5/1/2020 5/1/2021 ( p XXQQ(JQQ( X •ANY AUTO BODILY INJURY Per person) $ X AUTOS ONLY _SCHEDULED BODILY INJURY(Per accident$ XXXXXX}( X AUTOS ONLY X NON-OWNEDUUTPPROPERTY rr acci,lent DAMAGE $ XXXXXXX $ XXX000(X B X UMBRELLA LIAB X OCCUR N N XOO G27972032 005 5/1/2020 5/1/2021 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION$ $ XXXXXXX WORKERS COMPENSATION PER OTH- A AND EMPLOYERS'LIABILITY Y/N N MWC 313094 20 5/1/2020 5/1/2021 X STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE I- N/A E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Myandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 f describe under .. DESCRIPTION OF OPERATIONS below -- _ _ _ E.L.DISEASE-POLICY LIMIT S. 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Re:All Operations General Liability And Auto Liability Policies Include The City Of Ashland,Oregon,And Its Elected Officials,Officers And Employees As An Additional Insured When Required By Written Contract But Only As Respects Liability Arising Out Of Named Insured's Work For Additional Insured. CERTIFICATE HOLDER CANCELLATION I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 12424201 AUTHORIZED REPRESENTATIVE The City Of Ashland,Oregon Attn:Kari Ann Olson 90 N.Mountain Ave. • Ashland OR 97520 —..* ACORD 25(2016/03) ©1988-2015 ACORD CORPORATI .All rights reserved The ACORD name and logo are registered marks of ACORD Al& wQ April 06, 2020 Re: Quanta Services and all Subsidiaries Renewal Certificate of Insurance Dear Certificate Holder: Enclosed for your records you will find the renewal Certificate of Insurance for Quanta Services and its Subsidiaries. In order to expedite the delivery of future renewal certificates,we are collecting email addresses for all certificate holders. Please note that if no email address is on file, we will continue to mail a certificate of insurance to the mailing address on file. If you wish to receive E-mail version of renewal certificates going forward, please send the email address at which you would like to receive your certificate as well as the Certificate Holder number(see below for directions on how to locate this information)to the following email address: Houston-QuantaECertDeliverv@lockton.com Certificate Holder# ERTIFICATE HOLDER ^ The Certificate Holder number is 12345678 the 8 digit number directly above the Certificate Holder name and 12345678 4 address in the bottom left corner SAMPLE of your enclosed COI. 123 Main Sheet -- Anywhere AL 12345 :ORD 25/20161031 Regards, 2 r`) Amy Barnett