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HomeMy WebLinkAboutInsurance Certificate: RW Hays Co 6/27/2022 6:36 PM FROM_: SYSTEM TO: +15414885320 P. 2 ACCORD CERTIFICATE OF LIABILITY INSURANCE / DATE(MMlDD/YYYY) (`� • 06/27/2022}4.. THIS CERTIFICATE IS ISSUED ASA 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 NAME: Kim Wykes • Elliott Powell Baden and Baker Inc. PHONE (503)445-8441 FAX (503)445-8481 tA1G,No,EMI: (A/C,No): 4 An ISU Network Member ^I ��� (] ADMDARYESS: ykes©epbb.curn 1521 SW Salmon Street (V- �" INSURER(S)AFFORDING COVERAGE NAIC N Portland OR 97205=1783 INSURER A:. United States Fire Insurance Co. INSURED INSURER a: Certain Underwriters at Lloyds RW Hays Co INSURER C:. Endurance American Specialty Insurance Co. DBA:Hays Oil Company INSURER 0: PO Box 1220 INSURER E Medford OR 97501 INSURER F: - COVERAGES CERTIFICATE NUMBER: 22-23 GUAutoIMTC/XS 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-SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IVSD WVD . POLICY NUMBER • (MM/DDIYYYY) (MM(DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY ' EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100,000 CLAIMS-MADE n OCCUR PREMISES(Ea occurrence) $ _ MED EXP(Any one person) $ excluded , A Y 5069045817 07/01/2022 07/01/2023 PERSONAL RADV INJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: C3ENERALAGGREGATE $ 2,000,000 X POLICY n jECT LOC PRODUCTS-COMP/OP AGG $ 2.000,000 OTHER: Employee Benefits $ 1,000,000 •• AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A X OWNED SCHEDULED 5069045817 07/0112022 07/01/2023 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X AHIRTOSED ONLY X NON-AUTOOWNSONLY ED PROPERTY DAMAGE (Per accident) $ U . X CA 9948 X - _MCS-90 Uninsured motorist $ 1,000,000. UMBRELLA LIAB X OCCUR EACH OCCURR'NCE•• $ 5,000,000 B X EXCESS LIAB CLAIMS-MADE 22UKPCB220002530038805 07/0112022 07/01/2023. AGGREGATE $ 5,000,000 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y I N • STATUTE ER ANY PROPRIETORIPARTNER/EXECUTIVE 17 OFFICERJMEMBER EXCLUDED? N/A• E.L.EACH ACCIDENT S (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ UM.describe under DESCRIPTION OF OPERATIONS below . E.L.DISEASE-POLICY LIMIT $ Motor Truck Cargo • $70,000 Limit $1,000 Dad A Excess Liability , 5069045817/EXC30000382505 07/0112022 07/01/2023 $5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS(VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Re:Delivery of Fuel. CG 20 26 12 19 is attached.• ' . 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. 90 N Mountain Ave • AUTHORIZED REPRESENTATIVE Ashland OR 97520 j<{rM E +� • I J • ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 6/27/2022 6: 36 PM "FROM: SYSTEM TO: +15414885320 P. 3 • POLICY NUMBER: 5069045817 COMMERCIAL GENERAL LIABILITY CG 2Q 26 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE • Name Of Additional Insured Person(s)Or Organization(s): ANY PERSON OR ORGANIZATION THAT THE INSURED HAS AGREED BY WRITTEN CONTRACT OR WRITTEN AGREEMENT TO NAME AS AN ADDITIONAL INSURED AND EXECUTED PRIOR TO THE OCCURRENCE OF ANY LOSS. • • • • • Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section Ill —Limits Of Insurance: with respect to liability for "bodily injury", "property If coverage provided to the additional insured is damage" or "personal and advertising injury" • required by a contract or agreement, the most we caused, in whole or in part, by your acts or will pay on behalf of the additional insured is the omissions or the acts or omissions of those acting amount of insurance: on your behalf: 1. In the performance of your ongoing operations; 1. Required by the contract or agreement; or or 2. Available under the applicable limits of 2. In connection with your premises owned by or insurance; rented to you. whichever is less. However: This endorsement shall not increase the • 1. The insurance afforded to such additional applicable limits of insurance. insured only applies to the extent permitted by law; and " 2, If coverage provided to the additional insured is required by a contract or agreement, the • insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. • • • CO 20 26 12 19 ©Insurance Services Office, Inc., 2018 Page 1 of 1