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HomeMy WebLinkAboutInsurance Certificate:Arbor E&T LLC dba Rescare Workforce Services ..-------1e, DATE(MM/DD/YYYY) - .ACO/�U07105/2022 CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTEROF 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 CONTRACT,BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the'certificateholder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.If SUBROGATION IS WAIVED,subject to the terms andconditions of the policy,,certain policies may require an endorsement A statement on this t°.—t, certificate does not confer rights to the certificate holder in lieu of such endorsement(s). c PRODUCER CONTACT G! ' NAME: Aon Risk Services Central, Inc. Philadelphia PA Office (NC NNo.Ext): (866),283-7122 FAX No.): (800). 363-0105 - 100 North 18th street E-MAIL 15th Floor ADDRESS: 2 • Philadelphia PA 19103 USA • INSURER(S)AFFORDING COVERAGE NAIL# INSURED :INSURERA: ACE American Insurance Company' - 22667 . Arbor E&T, LLC INSURER B: Indian Harbor Insurance Company 36940 - dba ResCare Workforce Services 805 N. Whittington Pkwy ' INSURER C: Indemnity Insurance Co of North America 43575 Louisville KY 40222 USA • INSURER D: ACE Property & Casualty Insurance Co. 20699 ' INSURER'E: Lloyd's Syndicate No. 2623 AA1128623 - INSURER F: ; .. , COVERAGES CERTIFICATE NUMBER:570094434148 ' 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 CONTRACTOR 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. Limits shown are as requested INSR ADDL SUER POLICY EFF POLICY EXP LTR • TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY_ (MM/DD/YYYY) LIMITS A X'. COMMERCIAL GENERAL LIABILITY XSLG4730562/- 07/01/2022.07/01/2023 EACH OCCURRENCE $4,000,000 CLAIMS-MADE I-1 OCCUR Excess GL/Prof DAMAGE TO RENTED $3,000,000 SIR applies per policy terns & conditions PREMISES(Ea occurrence)' X Sexual Abuse/Molestation Included MED EXP(Any one person) X Professional Liability.Included PERSONAL&ADV,INJURY $4,000,000 v ,- GENII.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE - $6,000,000 X POLICY ❑PRO n LOC PRODUCTS-COMP/OPAGG $4,000,000 JECT I Icn • OTHER: o A AUTOMOBILE LIABILITY ISA.H10699460 07/01/2022 07/01/2023 COMBINED SINGLE LIMIT 1.0 $3,000,000 000,.000 (Ea accident) „ X ANY AUTO 'BODILY INJURY(Per person) C' _ Z' OWNED SCHEDULED BODILY INJURY(Per accident) d ' --- AUTOS ONLY '_ AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE hi. ONLY —AUTOS ONLY - (Per accident) i_ r• , D. _ UMBRELLALIAB X OCCUR XCQG72586104 001 ' 07/01/202207/01/2023 EACH OCCURRENCE $7,000,000 8- . X EXCESS LIAR' CLAIMS-MADE XS Auto & EL Only AGGREGATE $7,000,000 DED RETENTION - C WORKERS COMPENSATION AND WLRC70303723 - 07/01/2022 07/01/2023 •X •PER STATUTE 0TH- ' •. EMPLOYERS'LIABILITY Y/N . AOS ER ANY PROPRIETOR/PARTNER'/EXECUTIVE E.L.EACH ACCIDENT $2,000,000 A OFFICER/MEMBEREXCLUDED? N/A WLRC70303681 07/01/2022 07/01/2023 (Mandatory in NH) CA V . ' E.L.DISEASE-EA EMPLOYEE. $2,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below V E.L.DISEASE-POLICY LIMIT- $2,000,000— B E&O-MPL-Primary - MPP003397812. 07/01/2022 07/01/2023 Each Claim $5,000,000 Claims Made Aggregate $5,000,000 inin DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached It more space Is required) a_: Coverage applicable to work performed under the National Fish &"wildlife grant.--U-Q- .. CERTIFICATE HOLDER ' - CANCELLATION . a a SHOULD ANY.OF THE ABOVE DESCRIBED: POLICIES- BE CANCELLED. BEFORE THE a '. EXPIRATION DATE THEREOF, NOTICE WILL.BE DELIVERED IN ACCORDANCE WITH THE E , POLICY PROVISIONS. yy hX'. _ The City of Ashland AUTHORIZED REPRESENTATIVE . 20 East Main street , . 41.11c1 Ashland OR 97520 USA ` '� M 01988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000032784 LOC#: A ADDITIONAL REMARKS SCHEDULE Page _ of AGENCY - NAMED INSURED Aon RiskServices Central, Inc:. Arbor E&T, LLC POLICY NUMBER See Certificate Number: 570094434148 CARRIER NAIC CODE ',See.Certi fi cate Number: 570094434148, ' EFFECTIVE DATE: " ADDITIONAL REMARKS THIS ADDITIONAL REMARKS,FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Additional Coverages workers' Compensation Policies - 7/1/2022 7/1/2023 WLR 070303723' (All Other States) - Indemnity Insurance"Co. of North America, NAIC #43575; WLR C70303681 (CA`, AZ) - ACE American Insurance Co., NAIC #22667; SCF C70303760 (WI) - ACEFire underwriters Insurance Co., NAIC #20702; Cov. A Statutory Coy. B - $2,000,000"Each Accident "/ $2,000,000 Each Employee (Disease) / $2,000,000 Agg. (Disease) Ohio/Washington Excess workers' Compensation " Pol # WCU C70303607- ACE American Insurance Co., NAIC #22667; Cov. A - Statutory Cov..B $2,000,000 Each Accident / $2,000,000 Each Employee (Disease) / $2,000,000 Annual Aggregate Retention: $1,100,000 ACORD 101(2008/01) ©.2008 ACORD CORPORATION.Allrights reserved. . The ACORD name and logo are registered marks of ACORD