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HomeMy WebLinkAboutInsurance Certificate: S&S Sheetmetal Inc '4✓°® CERTIFICATE OF LIABILITY INSURANCE DATE0M31266/202,/2021 0 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 NAME: CLIENT CONTACT CENTER FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE:P.O.BOX 328 (A/C,No,Ext):888-333-4949 Inc,No):507-446-4664 OWATONNA,MN 55060 E-ADDRESS:CLI ENTCONTACTCENTERaFEDINS.COM INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 343_547-6 INSURER B: S&S SHEETMETAL INC INSURER C: 912 ANTELOPE RD WHITE CITY,OR 97503-1607 INSURER D: INSURER E: - INSURER F: COVERAGES CERTIFICATE NUMBER:126 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 POLICY EXP TYPE OF INSURANCE ADDL SUBR POLICY NUMBER (MM/DDIYYYFY) IMMIDDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000, CLAIMS-MADE n OCCUR PREMISES(Ea RENTED $100'000 MED EXP(My one person) EXCLUDED A Y Y 9910853 04/24/2021 04/24/2022 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 RPOLICY x IJECT LOC PRODUCTS-COMP/OP AGO $2,000,000 OTHER: AUTOMOBILE LIABILITY _ COMBINED SINGLE LIMIT $1,000,000 - (Ea accident) X ANY AUTO BODILY INJURY(Per person) A OWNED AUTOS ONLY AUT UED SY N 9910853 04/24/2021 04/24/2022 BODILY INJURY(Per accident — HIRED AUTOS ONLY NON-OWNED PROPERTY DAMAGE AUTOS ONLY (Per accident) X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $5,000,000 A EXCESS LIAB CLAIMS-MADE N N 9910854 04/24/2021 04/24/2022 AGGREGATE $5,000,000 DED (RETENTION WORKERS COMPENSATIONPER STATUTE ER OT AND EMPLOYERS'LIABILITY Y/ ANY PROPRIETORIPARTNERIEXECUTIVE E.L EACH ACCIDENT OFFICERIMEMBER EXCLUDED? N 1 A (Mandatory in NH) - E.L.DISEASE-EA EMPLOYEE It yes,describe under E.L DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space is required) - SEE ATTACHED PAGE CERTIFICATE HOLDER CANCELLATION 343-547-6 126 0 THE CITY OF ASHLAND OREGON SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 E MAIN ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ASHLAND,OR 97520-1814 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE O 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 343-547-6 LOC#: ACORD® ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED FEDERATED MUTUAL INSURANCE COMPANY S&S SHEETMETAL INC POLICY NUMBER 912 ANTELOPE RD SEE CERTIFICATE#126.0 WHITE CITY,OR 97503-1607 CARRIER NAIC CODE SEE CERTIFICATE#126.0 EFFECTIVE DATE:SEE CERTIFICATE#126.0 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE CERTIFICATE HOLDER NAME IS AMENDED TO READ THE CITY OF ASHLAND, OREGON ITS ELECTED OFFICIALS, OFFICERS & EMPLOYEES. PROJECT: HVAC SYSTEM INSTALL - NO. MOUNTAIN SHOP EFFECTIVE 07/28/14 THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, LESSORS OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU ENDORSEMENT FOR GENERAL LIABILITY. INSURANCE PROVIDED BY THE GENERAL LIABILITY COVERAGE IS PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE. GENERAL LIABILITY CONTAINS A WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) - AUTOMATIC ENDORSEMENT EACH CONSTRUCTION PROJECT AS REQUIRED BY WRITTEN CONTRACT OR WRITTEN AGREEMENT. THE CERTIFICATE HOLDER--IS-AN ADDITIONAL INSURED..SUBJECT.-TO..THE-CONDITIONS-OF--THE.ADDITIONAL-INSURED BY CONTRACT ENDORSEMENT FOR BUSINESS AUTO LIABILITY. ACORD 101(2008101) O 2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED BY CONTRACT ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A. WHO IS AN INSURED for"bodily injury" and "property damage" liability is amended to include: Any person or organization other than a joint venture, for which you have agreed by written contract to procure bodily injury or property damage "auto" liability insurance arising out of operation of a covered "auto"with your permission. However, this additional insurance does not apply to: (1) The owner or anyone else from whom you hire or borrow a covered "auto". This exception does not apply if'tlie covered "auto" is a."trailer" connected`.to a.covered.-"auto" you'own. (2) Your "employee" if the covered "auto" is owned by that "employee" or a member of his or her household. (3) Someone using a covered "auto" while he or she is working in a business of selling, servicing, repairing, parking or storing "autos" unless that business is yours. (4) Anyone other than your "employees", partners (if you are a partnership), members (if you are a limited liability company), or a lessee or borrower or any of their "employees", while moving property to or from a covered "auto". (5) A partner (if you are a partnership), or a member (if you are a limited liability company) for a covered "auto" owned by him or her or a member of his or her household. B. The coverage extended to any additional insured by this endorsement is limited to, and subject to all terms, conditions, and exclusions of the Coverage Part to which this endorsement is attached. In addition, coverage shall not exceed the terms and conditions that are required by the terms of the written agreement to add any insured, or to procure insurance. C. The limits of insurance applicable to such insurance shall be the lesser of the limits required by the agreement between the parties, or the limits provided by this policy. D. Additional exclusions. The insurance afforded to any person or organization as an insured under this endorsement does not apply: 1. To "loss"which occurs prior to the date of your contract with such person or organization; 2. To "loss" arising out of the sole negligence of any person or organization that would not be an insured except for this endorsement. 3. To "loss" for any leased or rented "auto" when the lessor or his or her agent takes possession of the leased or rented "auto"or the policy period ends, whichever occurs first. Includes copyrighted material of Insurance Services Office, Inc. with its permission. CA-F-127 (03-03) Policy Number: 9910853 Transaction Effective Date:04-24-2021 COMMERCIAL GENERAL LIABILITY CG 20 01 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract Condition and supersedes any provision to the or agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the This insurance is primary to and will not seek additional insured. contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and • • © Insurance Services Office, Inc., 2018 Page 1 of 1 CG 20 01 12 19 Policy Number: 9910853 Transaction Effective Date:04-24-2021 COMMERCIAL GENERAL LIABILITY CG 20 33 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN A WRITTEN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II - Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured any person or additional insureds, the following additional organization for whom you are performing exclusions apply: operations when you and such person or This insurance does not apply to: organization have agreed in writing in a contract 1. "Bodily or agreement that such person or organization be injury", "property damage" or added as an additional insured on your policy. "personal and advertising injury" arising out Such person or organization is an additional of the rendering of, or the failure to render, insured only with respect to liability for "bodily any professional architectural, engineering or injury", "property damage" or "personal and surveying services, including: advertising injury" caused, in whole or in part, by: a. The preparing, approving, or failing to 1. Your acts or omissions; or prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, 2. The acts or omissions of those acting on your change orders or drawings and behalf; specifications; or in the performance of your ongoing operations for b. Supervisory, inspection, architectural or the additional insured. engineering activities. However, the insurance afforded to such This exclusion applies even if the claims additional insured: against any insured allege negligence or other 1. Only applies to the extent permitted by law; wrongdoing in the supervision, hiring, and employment, training or monitoring of others 2. Will not be broader than that which you are by that insured, if the "occurrence" which required by the contract or agreement to caused the "bodily injury" or "property provide for such additional insured. . damage", or the offense which caused the A person's or organization's status as an "personal and advertising injury", involved the additional insured under this endorsement ends rendering of or the failure to render any when your operations for that additional insured professional architectural, engineering or are completed. surveying services. © Insurance Services Office, Inc., 2018 Page 1 of 2 CG 20 33 12 19 Policy Number: 9910853 Transaction Effective Date:04-24-2021 • 2. "Bodily injury" or "property damage" C. With respect to the insurance afforded to these occurring after: additional insureds, the following is added to a. All work, including materials, parts or Section III - Limits Of Insurance: equipment furnished in connection with The most we will pay on behalf of the additional such work, on the project (other than insured is the amount of insurance: service, maintenance or repairs) to be 1. Required by the contract or agreement you performed by or on behalf of the additional have entered into with the additional insured; insured(s) at the location of the covered or operations has been completed; or 2. Available under the applicable limits of b. That portion of "your work" out of which insurance; the injury or damage arises has been put to its intended use by any person or whichever is less. organization other than another contractor This endorsement shall not increase the or subcontractor engaged in performing applicable limits of insurance. operations for a principal as a part of the same project. Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 33 12 19 Policy Number: 9910853 Transaction Effective Date: 04-24-2021 COMMERCIAL GENERAL LIABILITY CG 24 53 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) - AUTOMATIC This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV -Conditions: We waive any right of recovery against any person or organization, because of any payment we make under this Coverage Part, to whom the insured has waived its right of recovery in a written contract or agreement. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person or organization prior to loss. © Insurance Services Office, Inc., 2018 Page 1 of 1 CG 24 53 12 19 Policy Number: 9910853 Transaction Effective Date:04-24-2021 POLICY NUMBER: 9910853 COMMERCIAL GENERAL LIABILITY CG 25 03 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): Each construction project as required by written contract or written agreement. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally 3. Any payments made under Coverage A for obligated to pay as damages caused by damages or under Coverage C for medical "occurrences" under Section I -Coverage A, and for expenses shall reduce the Designated all medical expenses caused by accidents under Construction Project General Aggregate Limit Section I - Coverage C, which can be attributed only for that designated construction project. Such to ongoing operations at a single designated payments shall not reduce the General construction project shown in the Schedule above: Aggregate Limit shown in the Declarations nor 1. A separate Designated Construction Project shall they reduce any other Designated General Aggregate Limit applies to each Construction Project General Aggregate Limit designated construction project, and that limit for any other designated construction project is equal to the amount of the General shown in the Schedule above. Aggregate Limit shown in the Declarations. 4. The limits shown in the Declarations for Each 2. The Designated Construction Project General Occurrence, Damage To Premises Rented To Aggregate Limit is the most we will pay for You and Medical Expense continue to apply. the sum of all damages under Coverage A, However, instead of being subject to the except damages because of "bodily injury" or General Aggregate Limit shown in the "property damage" included in the "products- Declarations, such limits will be subject to the completed operations hazard", and ' for applicable Designated Construction Project medical expenses under Coverage C General Aggregate Limit. regardless of the number of: a. Insureds; b. Claims made or"suits" brought; or c. Persons or organizations making claims or bringing "suits". © Insurance Services Office, Inc., 2008 Page 1 of 2 CG 25 03 05 09 Policy Number: 9910853 Transaction Effective Date: 04-24-2021 B. For all sums which the insured becomes legally C. When coverage for liability arising out of the obligated to pay as damages caused by "products-completed operations hazard" is "occurrences" under Section I - Coverage A, and provided, any payments for damages because of for all medical expenses caused by accidents "bodily injury" or "property damage" included in under Section I - Coverage C, which cannot be the "products-completed operations hazard" will attributed only to ongoing operations at a single reduce the Products-completed Operations designated construction project shown in the Aggregate Limit, and not reduce the General Schedule above: Aggregate Limit nor the Designated Construction 1. Any payments made under Coverage A for Project General Aggregate Limit. damages or under Coverage C for medical D. If the applicable designated construction project expenses shall reduce the amount available has been abandoned, delayed, or abandoned and under the General Aggregate Limit or the then restarted, or if the authorized contracting Products-completed Operations Aggregate parties deviate from plans, blueprints, designs, Limit, whichever is applicable; and specifications or timetables, the project will still 2. Such payments shall not reduce any be deemed to be the same construction project. Designated Construction Project General E. The provisions of Section III - Limits Of Insurance Aggregate Limit. not otherwise modified by this endorsement shall continue to apply as stipulated. Page 2 of 2 © Insurance Services Office, Inc., 2008 CG 25 03 05 09 Policy Number: 9910853 Transaction Effective Date:04-24-2021