HomeMy WebLinkAboutInsurance Certificate: S&S Sheetmetal Inc i
ACORCP DA'E(MM/D
CERTIFICATE OF LIABILITY INSURANCE
031,82020
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
FEDERATED MUTUAL INSURANCE COMPANY NAME: CLIENT CONTACT CENTER
HOME OFFICE:P.O.BOX 328 (A/C,No,Ext):888-333-4949 (A C, No):507-446-4664
OWATONNA,MN 55060 ADDRESS:CLI ENTCONTACTCENTER(IFEDINS.COM
INSURER(S)AFFORDING COVERAGE NAIC#
INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935
INSURED 343_547-6 INSURER B:
S&S SHEETMETAL INC I INSURER C
912 ANTELOPE RD
WHITE CITY,OR 97503-1607 INSURER D:
INSURER E:
INSURER F: 1
COVERAGES CERTIFICATE NUMBER:245 REVISION NUMBER:0
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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY En? POLICY EXP LIMITS
LTR -INSR WVD I (MM/DDIYYYY) (MM/DD(YYVY)
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000
ri DAMAGE TO RENTED $100,000
CLAIMS-MADE OCCUR PREMISES(Ea occurrence) _
MED EXP(Any one person) EXCLUDED
A N N 9910853 04/24/2020 04/24/2021 PERSONAL&ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPUES PER: GENERAL AGGREGATE $2,000,000
X POLICY TA,
H LOC PRODUCTS-COMP/OP AGO $2,000,000
OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE UMIT $1,000,000
Ma accident)
X ANY AUTO BODILY INJURY(Per person)
—
A OWNED AUTOS ONLY AUTOSULED N N 9910853 04/24/2020 04/24/2021 BODILY INJURY(Per accident)
—
HIRED AUTOS ONLY NON-OWNED PROPERTY DAMAGE
AUTOS ONLY (Per eeeldend
X UMBRELLA LIAB X OCCUR I EACH OCCURRENCE $5,000,000
A EXCESS UAB CLAIMS-MADE N N 9910854 04/24/2020 04/24/2021 AGGREGATE _ $5,000,000
'DED I !RETENTION
WORKERS COMPENSATION I PER STATUTE ER
0T
AND EMPLOYERS'LIABILITY Y/N
ANY PROPRIETORIPARTNERIEXECUTIVEE.L.EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? I N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE
It yes,describe under '
DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT
I
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
CERTIFICATE HOLDER CANCELLATION
343-547-6 245 0
CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
90 N MOUNTAIN AVE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ASHLAND,OR 97520-2014 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE (/` 1
! V J / ,
O 1988-2015 ACORD CORPORATION.All rights reserved.
ACORD 25(2018103) The ACORD name and logo are registered marks of ACORD
1
CITY ,.RECORDER