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HomeMy WebLinkAboutInsurance Certificate: Newco, Inc. dba Cascade Columbus Distr. Co. (2) Aco O® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) • `.•'- • 10/31/2023 • 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(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: Kelsey Spaniel Arthur J. Gallagher Risk Management Services, LLC PHONE - FAX 777 108th Avenue NE, Suite 200 (A/C.No.Ext):425-586-1011 (A/c,Nol:425-451-3716 Bellevue-WA 98004 ADDRESS: Kelsey spaniel©alq.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:AIG Insurance Company of Canada INSURED NEWCINC-02 INSURER B:National Union Fire Insurance Co of LA - 32298 Newco, Inc.dba Cascade Columbia Distribution Company INSURER c:Aspen Specialty Insurance Company 10717 • • . 6900 Fox Ave.S INSURER D: • Seattle WA 98108 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:217183604 • 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. TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY Y 14260808-02 10/31/2023 10/31/2024 EACH OCCURRENCE $1,000,000 • CLAIMS-MADE X OCCUR - DAMAGE TO RENTED PREMISES(Ea occurrence) $1,000,000 MED EXP(Any one person) $25,000 • X Vendors Liab. PERSONAL&"ADV INJURY $1,000,000 , GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO POLICY X JECT LOC • PRODUCTS-COMP/OPAGG $2,000,000 OTHER: $• c B AUTOMOBILE LIABILITY Y 184-12-558 10/31/2023 10/31/2024 COMBaccidenINEDt)SINGLE LIMIT $1,000,000 (Ea X ANY AUTO - BODILY INJURY,(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS ' X HIRED . NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) _ A X UMBRELLA LIAB X OCCUR 14260809-02 10/31/2023 10/31/2024 EACH OCCURRENCE• $10,000,000 EXCESS LIAB CLAIMS-MADE • • AGGREGATE $ ' DED RETENTION$ _ $ 1 A WORKERS COMPENSATION 14260808-02 10/31/2023. 10/31/2024 PER X OTH- AND EMPLOYERS'LIABILITT Y/N _ STATUTE_ ER. WA Stop Gap • ANYPROPRIETORIPARTNER/EXECUTIVEN/A _ E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED? .. (Mandatory in NH) . E.L.DISEASE-EA EMPLOYEE $1,000,000 E yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 . A Pollution Legal Liability 14260808-02 10/31/2023 .10/31/2024 Each Loss Limit ,' •$1,000,000 C Excess Liability EX00XYF23 10/31/2023 10/31/2024 Per Occurrence 10,000,000 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. 20EMain - • •Ashland OR 97520 AUTHORIZED REPRESENTATIVE USA • • \gym, _ • . ©1988-2015 ACORD CORPORATION. All rights'reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 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,the insurance provided 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. AUTHORIZED REPRESENTATIVE 87950 (9/14) Includes copyrighted material of Insurance Services Office, Inc.with its permission. Page 1 of 1 POLICY NUMBER: 184-12-558 COMMERCIAL AUTO 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 D • • 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 7 respect to bodily injury, property damage, environmental. damage, or emergency response costs arising out of your products shown in the Schedule above which 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 response costs 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 solely for the purpose of inspection,demonstration,testing,or the substitution of parts under instructions from the manufacturer,and then repackaged in the original container; e. Any failure to make such inspections, adjustments,tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business,in connection with the distribution or sale of your product; f. Demonstration, installation,.servicing or repair operations, except such operations performed at the•vendor's 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.orf.above;or (2) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of your product. 2. This insurance does not apply to any products you have acquired from a vendor, or any ingredient, part or container,entering into,accompanying or containing such products. 3. Solely with respect to the coverage afforded to thevendor pursuant 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 primary and 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 . ` UTH IZE T'RESEN. TIVE • Or countersignature(where required by law) • 103388(10/09) Page 2 of 2 CI4401 • ENDORSEMENT NO.5 1 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. 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 by the 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 ongoing operations or your work done under a contract with that person or organization and included in the products-completed operations hazard. This waiver applies only to the 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 same. . • • UTH IZE EPRESEN ATIVE Or countersignature(where required by law) 94283(3/07) PAGE 1 OF 1 • C13021