Loading...
HomeMy WebLinkAboutInsurance Certificate: Newco, Inc. dba Cascade Columbia Distrib. Co. ® DATE(MM/DD/YYYY) ARD® CERTIFICATE OF LIABILITY INSURANCE 8/1/2023 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(les)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 Stephen Emi - . Arthur J.Gallagher Risk Management Services, LLC'. PHONE i x 777 108th Avenue NE,Suite 200 (ac No;Exn:425-586-1002 tic Nor.425 451=3716 E-MAIL @ jg• Bellevue WA 98004 ADDRESS: Stephen_Erni a' com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A r National Union Fire Insurance'Company of Pittsburg 19445 INSURED "NEWCINC-02 _ INSURER B:AIG Specialty InsuranceCompany - 26883. Newco, Inc.dba Cascade Columbia Distribution Company . ` INSURER C: 6900 Fox Ave.S INSURER D_; Seattle WA 98108 INSURER E: • INSURER F:. COVERAGES CERTIFICATE NUMBER:962543844 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. ITR TYPEOFINSURANCE NSD WVD .. POLICY NUMBER (MM/DD/YYYY) (MM/DDNYYY) LIMITS_ B. X COMMERCIAL GENERAL LIABILITY , .V" 14260808-01. 10/3112022' 10/31/2023 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $1,000,000 X Pollution Liab. MED EXP(Any one person) $25,000 X Vendors Liab• PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000, POLICY X 8: X LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: A AUTOMOBILE LIABILITY Y 018-41-2558 -, • • 10/31/2022. 10/31/2023 YEa aac tleotSINGLE LIMIT $1,000,000 — X ANY AUTO BODILY INJURY(Per parson) $ OWNED ` SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED - PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ B UMBRELLALIAB X OCCUR '14260809-01 10/31/2022 .10/31/2023 EACH OCCURRENCE` $20;000,000 X EXCESS LIAB CLAIMS-MADE , AGGREGATE $20,000,000 • DED RETENTION$' $ B. WORKERS COMPENSATION ,,; ' '14260808-01 10/31/2022 -10/31/2023 E` X gr AND EMPLOYERS'LIABILITY WA Stop Gap ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N NlA^ E.LSTATUT EACHACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED?, • _ - (Mandatory in NH) E.L..DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL.DISEASE'-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS'/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule may be attached if more space is required) ' Regarding current project and contract,The City of Ashland is listed as an additional insured for General Liability and Automobile Liability • CERTIFICATE HOLDER CANCELLATION " .` - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN • City of Ashland, ACCORDANCE WITH THE POLICY PROVISIONS. 20 E Main. USA Ashland OR 97520, '. ' AUTHORIZED REP TATIVE - • ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25.(2016/03) The ACORD name and logo are registered marks of ACORD Arthur J. Gallagher Risk Management Services, LLC 777 108th Avenue NE, Suite 200 Bellevue WA 98004 MDG2023 0001 1219 01 1111111n11uiJ i1aini111111hil111114'11111h'iiil iiirl11111i1l DaCity of Ashland 20 E Main Ashland, OR 97520 We are providing you with a Certificate of Insurance confirming our client's coverage. Want to get certificates of insurance faster? "Go Green with Gallagher" by receiving digital copies of certificates via e-mail in the future. Or, do you no longer require a certificate of insurance for our client'? Please contact us at COI.UpdateMyEmail@AJG.com and provide the following information for processing:... 1. Confirmation that a certificate of insurance is no longer required, or 2. E-mail address to send future certificates of insurance in lieu of U.S. Mail delivery 3. Insured Code: NEWCINC-02 4. This Certificate Number: 962543844 To learn more about the Insurance and Risk Management Services offered by Gallagher, please visitusat www.ajg.com/us/about-us/how-we-work/core-360. Gallagher. does not share your e-mail as detailed in our privacy policy found at https:// www.ajg.com/us/privacy-policy/. . . o 0 0 00 • ENDORSEMENT This endorsement, effective 12:01 A.M. 10/31/2022 forms a part of Policy No. • 184-12.558 issued to NEWCO, INC. DBA CASCADE COLUMBIA DISTRIBUTION COMPANY by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. ADDITIONAL INSURED-WHERE REQUIRED UNDER CONTRACT OR AGREEMENT This endorsement modifies insurance provided'under the following: BUSINESS AUTO COVERAGE FORM SCHEDULE ADDITIONAL INSURED: BLANKET WHERE REQUIRED BY WRITTEN,CONTRACT OR AGREEMENT. I. 'SECTION II - COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 1. - Who Is Insured, is amended to add: d. Any :person, or organization, 'shown in the schedule above, to whom you become obligated to include as an•additional insured under this policy,as.a result of any:contract or agreement you enter into which requires you to.furnish insurance to that person or organization of the. type provided by this policy, but only with respect to liability arising out of use,of a covered. "auto". However,,theinsuranceprovided will not exceed the lesser.of: (1) The coverage and/or limits of this policy,or (2) The coverage and/or limits required by said contract or agreement. a. AUTHORIZED REPRESENTATIVE o o . N O ' O 87950 (9/14)' Includes copyrighted material of Insurance Services Office,Inc.with its permission. Page 1 of 1 POLICY NUMBER: 1$4-12COMMERCIAL AUTO -558 CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.' WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the'following: AUTO DEALERS COVERAGE.FORM BUSINESS AUTO COVERAGE FORM. MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement,the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: NEWCO, INC. DBA CASCADE COLUMBIA DISTRIBUTION COMPANY Endorsement Effective Date: 10/31/2022 SCHEDULE Name(s)Of Person(s) Or Organization(s): BLANKET WHERE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT Information required to complete this Schedule,if not.shown above,will be shown in the Declarations. The,Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule; but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. CA 04 44 10 13 ®Insurance Services Office, Inc:, 2011 Page 1 of 1 ❑ ENDORSEMENT NO.12 This endorsement,effective 12:01 AM,10/31/2022 Forms a part of Policy No:14260808=01 Issued to:Newco,Inc.DBA Cascade Columbia Distribution Company By:AIG Specialty Insurance Company THIS ENDORSEMENT.CHANGES THE POLICY.PLEASE READ IT CAREFULLY. ADDITIONAL INSURED VENDORS ENDORSEMENT-PRIMARY AND NON-CONTRIBUTORY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY AND POLLUTION LEGAL LIABILITY COVERAGE FORM SCHEDULE Name of Person(s)or Organization(s)(Vendor); Where required by written contract when such contract was signed and executed prior to the sale,distribution,handling or transfer of your product Your Products: All products sold,handled or distributed by the insured Solely as respects Coverages A, •E-1,`E-2 and E-3,if applicable,SECTION II.-'WHO IS AN INSURED is amended to include as an insured any person(s) or organization(s) (referred to herein as the"vendor") shown in the Schedule above, but only with respect to bodily injury, property damage, environmental damage, or emergency response costs arising out of your products shown in the Schedule abovewhich are distributed or sold in the regular course of the vendor's business,subject to. all of the terms and conditions of this Policy and the additional following exclusions,terms and conditions: 1. The insurance afforded the vendor does not apply to: a. Bodily injury, property damage, environmental damage, or emergency responsecosts for which the vendor is obligated to pay damages by reason of the assumption of liability in a'contract or agreement.This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; b. Any express warranty unauthorized by you; c. Any physical or chemical change in your product made intentionally by the vendor;. d. Repackaging;except when unpacked solelyfor the purpose of inspection,demonstration,testing,or the substitution of parts under instructions from the manufacturer,and then repackaged in the original container; a e. Any failure to make such inspections,adjustments,tests or servicing as the vendor has agreedto make or normally undertakes to make.in the;usual course of business,'in connection with the distribution or sale of your product; o 0, f. Demonstration, installation; servicing or repair operations, except such operations'performed at the vendor's o premises in connection with the sale of your product; 103388(10/09) PAGE 1 O 2 CI4401 • ENDORSEMENT NO.12 CONTINUED g. Your product which,after distribution or sale by you,has been labeled or relabeled,or used as a container, part or ingredient of any other thing or substance,by or for the vendor;or h. Bodily injury, property damage, environmental damage or emergency response costs arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf.However,this exclusion does not apply to: (1).The exceptions contained in Sub-paragraphs d.or f:above;or (2) Such inspections, adjustments, tests or servicing as the. vendor"has agreed to make or normally p , 1 , undertakes to make in the usual course of business,in connection with the distribution or sale of your product:. 2. This insurance does notapply to any products you have acquired froma vendor,orany ingredient,part or container,entering into,accompanying or containing such products.' 3. Solely with respect to the coverage afforded to the vendorpursuant to this-Endorsement, SECTION IV- CONDITIONS,paragraph 4:Other Insurance is deleted in its entirety and replaced with the following: 4. Other Insurance This insurance is primaryand non-contributory,and our obligations are not affected by any other insurance carried by such vendor whether primary,excess,contingent,or on any other basis.: All other terms,conditions,and exclusions shall remain the same UTI- IZ RESEN TIVE Or countersignature(where required by law) 103388(10/09) Page 2 of 2 CI4401 ENDORSEMENT NO.5 This endorsement,effective 12:01 AM,10/31/2022 Forms apart of Policy No:14260808-01, Issued to:Newco,Inc.DBA Cascade Columbia Distribution.Company By:AIG Specialty Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY. AGAINST OTHERS TO US ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY AND POLLUTION LEGAL LIABILITY COVERAGE FORM . * It is hereby agreed as follows: SECTION IV-CONDITIONS,Paragraph 7.Transfer of Rights of Recovery Against Others to Us—Applicable to Coverages A,B, C and E is amended bythe addition of the following at the end of such subparagraph: We waive any right of recovery we may have against the person or organization shown in the Schedule below because of payments we make under Coverage A,B, C and E for injury or damage arising out of your ongoingoperations or your work done under a contract with that person or organization and included'in the products-completed operations hazard. This waiver applies only tothe person or organization shown in the Schedule below. SCHEDULE Name of Person or Organization: Blanket where required by written contract or.agreement. :. All other terms,conditions,and exclusions shall remain the 0 ' rn UTH IZE EPRE$EN ATIVE 0 Or countersignature(where required bylaw) g 94283(3/07) PAGE 1O 1 S CI3021