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HomeMy WebLinkAboutInsurance Certificate: Altec Industries, Inc. • ,,•'''''.'", ® DATE(MMIDDIYYYY) ACORO CERTIFICATE OF LIABILITY INSURANCE 05/29/2020 Lam" 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 Bridgette Taul NAME: 9 MCGRIFF,SEIBELS&WILLIAMS,INC. PHONE800-476 2211 FAX P.O.Box 10265 INC.No.Ext): (A/C,No): Birmingham,AL 35202 AIL ADDRESS:btaul@mcgriff.com - 1 INSURER(S)AFFORDING COVERAGE NAIC S • - INSURER A:Lexington Insurance Company • 19437 INSURED INSURER B:Hartford Fire Insurance Company 19682 Altec Industries,Inc. 1450 N 1st.Street INSURER C:AIG Specialty Insurance Company 26883 Dixon,CA 95620 INSURER D:Trumbull Insurance Company • 27120 INSURER E:Hartford Casualty Insurance Company 29424 _ INSURER F: COVERAGES CERTIFICATE NUMBER:W5BU4PVB 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 HAVEIBEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE IVSD WVD POLICY NUMBER (MMIDDY�) (MM/DDY�) LIMITS • A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE n OCCUR 013136094 06/01/2020 06/01/2021 EACH OCCURRENCEDAMAGE TO RM ED $ 5,000,000 PREMISES(Ea occu occurrence) $ 3,000,000 MED EXP(Any one person) $ N/A X PERSONAL&ADV INJURY $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,000 X POLICY n PROT LOC PRODUCTS-COMP/OP AGG $ ,' 10,000,000 JEC OTHER: ' $ B AUTOMOBILE LIABILITY 21CSES27903 06/01/2020 06/01/2021 COMBINED SINGLE LIMIT 3,000,000 (Ea accident) $ X ANY AUTO BODILY INJURY(Per person) $ OWNED ^SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS — HIREDNON-OWNED PROPERTY DAMAGE $ X ,AUTOS ONLY y AUTOS ONLY : (Per accident) $ C X UMBRELLA LIAB X OCCUR 18895685 06/01/2020 06/01/2021EACH OCCURRENCE $ 10,000,000 EXCESS LIAB10,000,000 CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ D WORKERS COMPENSATION 21WNS27900(AOS) 06/01/2020 06/01/2021X STATUTE ER E E AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 21XWES27902(AL,MO,NC) E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A I1,000,000 (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 I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached It more space le required) The City of Ashland,Oregon,its officers,agents and employees are additional insured under General Liability and Automobile Liability on a primary and non-contributory basis as required by written contract.See cancellation endorsement form attached. CERTIFICATE HOLDER CANCELLATION • SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland AUTHORIZED REPRESENTATIVE 4,0111,11;& 20 East Main Street Ashland,OR 97520 Page 1 of 4 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD • Altec, Inc. Policy No. 21CSES27903 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO CERTIFICATE' HOLDER(S) This policy is subject to the following additionalon file with the agent of record will be sufficient Conditions: proof of notice. If this policy is cancelled by the Company, other Any notification rights provided by this than for nonpayment of premium, notice of such endorsement apply only to active certificate cancellation will be provided to the certificate holder(s) who were issued a certificate of holder(s) with mailing addresses on file with the insurance applicable to this policy's term. agent of record. Such notice will be provided Failure to provide such notice to the certificate within 30 days of the Company's receipt of holder(s) will not amend or extend the date the, certificate holder(s) information from the agent of cancellation becomes effective, nor will it negate record. cancellation of the policy. . Failure to send notice If notice is mailed, proof of mailing to the last 'shall impose no liability of any kind upon the known mailing address of the certificate holder(s) Company or its agents or representatives. • • • j3. I Form IH 0310 06 11 Page 1 of 1 © 2011,The Hartford Page 2 of 4 J W5BU4PVB ENDORSEMENT#.038'' 1 Forms a part of policy no.: 01313$094 Issued to: :ALTEC, INC,. ATTN: MARK BERTOVIC By: LEXINGTON INSURANCE COMPANY ADVICE OF CANCELLATION TO ENTITIES OTHER THAN THEIII NAMED INSURED:i.ii1AITED 7'O E-MAiI. NOTIFICATION This policy is amended as.follows:. In the event that the Insurer cancels this policy for any reason other than non paymentof premium, and 1, The cancellation effective date isprior tothispolicy's expiration date; 2. The First Named Insured is.under an existing contractual obligation to notify a certificate holder when this policy is canceled (hereinafter, the;"Certificate Holder(s)") :end`has provided to the Insurer, either directly or through its broker of record,the email address of the contact i at.such entity, and the insurer received this information after the First. Named Insured receives notice of cancellation of thispolicy and prior to this:policy's cancellation effective date, via an electronic spreadsheet that is acceptable to the Insurer, the Insurer will provide advice of cancellation (the:'Advice")via e-mail to such Certificate Holders: Proof of the Insurer emailing the Advice, using the information provided by the First Named Insured, will serve as proof that the:insurer has fully satisfied its obligations under this endorsement. This endorsement does not affect, in any way, coverage provided under this policy or.the cancellation of this policy or the effective date thereof, nor shall this endorsement,invest any rights in any entity not insured under this policy. The following Definitions apply to this endorsement; 1 First Named Insured means the.Named Insured shown on the.Declarations Page,:of this.policy. 2. Insurer means the insurance company shown in the header .on the Declarations Page of this policy. All other terms and conditions remain,unchanged. i reD,..J &Way.' Authorized Representative OR. Countersignature(in states where applicable) LEXD00O21 LX0404 Page 3 of 4 W5BU4PVB Altec, Inc. 4, Policy No. 21 WNS279'00 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S) This policy is subject to the following additional on file with the agent of record will be sufficient Conditions: proof of notice. If this policy is cancelled by the Company, other Any notification rights provided by this than for nonpayment of premium, notice of such endorsement apply only to active certificate cancellation will be provided to the certificate holder(s) who were issued a certificate of holder(s) with mailing addresses on file with the insurance applicable to this policy's term. agent of record. Such notice will be provided Failure to provide such notice to the certificate within 30 days of the Company's receipt of holder(s) will not amend or extend the date the certificate holder(s) information from the agent of cancellation becomes effective, nor will it negate record. cancellation of the policy. Failure to send notice If notice is mailed, proof of mailing to the last shall impose no liability of any kind upon the known mailing address of the certificate holder(s) Company or its agents or representatives. is Form IH 0310 06 11 Page 1 of 1 c0 2011,The Hartford Page 4 of 4 W5BU4PVB