HomeMy WebLinkAboutInsurance Certificate: American Industrial Door LLC (2) ACCORD DATE iMMAENTTTT)
06/132
CERTIFICATE OF LIABILITY INSURANCE 6„32D22
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
FEDERATED MUTUAL INSURANCE COMPANY NAME: CLIENT CONTACT CENTERPHONE
HOME OFFICE:P.O.BOX 328 (A/C,No,Exl):888-333-4949 FAX No):507-446-4664
OWATONNA,MN 55060 E-ADDRESS:CLI ENTCONTACTCENTER(aFEDINS.COM
INSURER(S)AFFORDING COVERAGE NAIC#
INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935
INSURED 391-637-6 INSURER B:
AMERICAN INDUSTRIAL DOOR,LLC INSURER C:
6142 CRATER LAKE AVE
CENTRAL POINT,OR 97502-9414 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:29 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
LTR INSR WrID IMMIDDIYYYY) IMMIDDIYYYY}
X COMMERCIAL GENERAL UABIUTY EACH OCCURRENCE $1,000,000
CLAIMS•MADE X OCCUR DAMAGE TO RENTED $100,000
PREMISES lEa occurrence)
MED EXP(Any one person) EXCLUDED
A N N 9841842 07/06/2022 07/06/2023 PERSONAL h ADV INJURY $1,000,000
OE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
X POUCY 2e,-. n LOC PRODUCTS-COMP/OP AGG $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 —AUTOSULED N N 9841842 07/06/2022 07/06/2023 BODILY INJURY(Per accident
HIRED AUTOS ONLY
NON-OWNEDPROPERTYDAMAGE
AUTOS ONLY (Per accident)
X UMBRELLA LIAB X OCCUR I EACH OCCURRENCE $5,000,000
,_
A EXCESS LIAB CLAIMS•MADE N N 9841843 07/06/2022 07/06/2023 AGGREGATE _ $5,000,000
DED RETENTION
WORKERS COMPENSATION OTH-
AND EMPLOYERS'LIABILITY Y/N PER STATUTE ER
MY PROPRIETORIPARTNERIEXECUTIVE E.L EACH ACCIDENT
OFFICERIMEMBER EXCLUDED? N I A
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
CERTIFICATE HOLDER CANCELLATION
391-637-6 29 0
CITY OF ASHLAND PUBLIC WORKS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
90 N MOUNTAIN AVE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN
ASHLAND,OR 97520-2014 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE YEA,..
O 1988-2015 ACORD CORPORATION.All rights reserved.
ACORD 25(2018103) The ACORD name and logo are registered marks of ACORD
391-637-6 29
#BWNDHBS BE000-09-0164
#XWXW0021 XXXXXXX5#
CITY OF ASHLAND PUBLIC WORKS
90 N Mountain Ave
Ashland, OR 97520-2014