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HomeMy WebLinkAboutInsurance Certificate: Van Row Mechanical Inc VANROWM-01 KANDREW ,ac R a CERTIFICATE OF LIABILITY INSURANCE DAT24/2D/YYYY) 3//24/2021 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 CONE CT Kay Andrew • WAFD Insurance Group,Inc. PHONE (503)357-7111 I FAx PO BOX'327 (A/c,No,Ext): (AIC,No): 1909 Cedar StAIL,ADDRESS:kay@pacificinspartners.com Forest Grove,OR-97116 INSURER(S)AFFORDING COVERAGE NAIC#' • INSURER A:Gemini Insurance Company' INSURED INSURER B:SAIF Van Row Mechanical Inc INSURER C:Ohio Security Insurance Company 24082 PO Box 3813 INSURER D: Central Point,OR 97502 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYYI (MM/DD/YYYY! A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X VCGP026369 3/12/2021 3/12/2022 DAMAGE TO RENTED 50,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1'000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ - 2,000,000 POLICY X JECT PRO" LOC PRODUCTS-COMP/OP AGG $ 2,000,000 . _ .. . 'OTHER: $ AUTOMOBILE LIABILITY Ea aMcccidentSINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ _ OWNED SCHEDULED . AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ $ _ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 760659 5/1/2020 5/1/2021 E.L.EACH ACCIDENT $ 2,000,000 OFFICER/MEMBER BER EXCLUDED? N I A 2,000,000 NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 2,000,000 DESCRIPTION OF OPERATIONS belowE.L.DISEASE-POLICY LIMIT $. C Inland Marine BKS57429208 7/6/2020 7/6/2021 Installation Limit 100,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) City of Ashland,Oregon and its elected officials,officers and employees are additional insureds to the extent of coverage under form CG2012 1219. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Ashland,Oregon THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main St I • Ashland,OR 97520 AUTHORIZED REPRESENTATIVE I /5'444-) ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Policy Number: VCGP026369 CG 20 12 12 19 Insured Name: Van Row Mechanical, Inc. Number: 39 Effective Date:03/12/2021 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part Schedule State Or Governmental Agency Or Subdivision Or Political Subdivision: Any qualifying entity when you have agreed in a written and executed contract, prior to an "occurrence", that such qualifying entity be added as an additional insured on your policy. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section ll—Who Is An Insured is amended to 2. This insurance does not apply to: include as an additional insured any state or governmental agency or subdivision or political a. "Bodily injury", "property damage" or subdivision shown in the Schedule, subject to "personal and advertising injury" arising the following provisions: out of operations performed for the 1. This insurance applies only with respect to federal government, state or operations performed by you or on your municipality; or behalf for which the state or governmental b. "Bodily injury" or "property damage" agency or subdivision or political subdivision included within the "products-completed has issued a permit or authorization. operations hazard". However: B. With respect to the insurance afforded to these a. The insurance afforded to such additional additional insureds, the following is added to Section III—Limits Of Insurance: insured only applies to the extent permitted by law; and If coverage provided to the additional insured is required by a contract or agreement, the most b. If coverage provided to the additional we will pay on behalf of the additional insured is insured is required by a contract or the amount of insurance: agreement, the insurance afforded to such additional insured will not be 1. Required by the contract or agreement; or broader than that which you are required 2. Available under the applicable limits of by the contract or agreement to provide insurance; for such additional insured. whichever is less. This endorsement shall not increase the applicable limits of insurance. CG 20 12 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2 All other terms and conditions of this Policy remain unchanged. CG 20 12 12 19 © Insurance Services Office, Inc., 2018 Page 2 of 2