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HomeMy WebLinkAboutInsurance Certificate: S&S Sheetmetal Inc. CCPREP A CERTIFICATE OF LIABILITY INSURANCE DATE 03112022 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 POUCIES 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 andconditions 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 CENTER PHONE HOME OFFICE:P.O.BOX 328 (A/C,No,Eel):888-333-4949 FAX o, No):507-446-4664 OWATONNA,MN 55060 AE-MAIL CLI ENTCONTACTCENTER(c11FEDINS.COM INSURER(S)AFFORDING COVERAGE NAIC/I INSURER A:FEDERATED RESERVE INSURANCE COMPANY 16024 INSURED 343_547-6 INSURER B: S&S SHEETMETAL INC INSURER C: 912 ANTELOPE RD WHITE CITY,OR 97503-1607 INSURER D: • INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:188 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 ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR YAM POLICY NUMBER (MM/DDIYYYYI IMM/DDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE n OCCUR DAMAGE TO RENTED $100,000 PREMISES IEa occurrence) MED EXP(Any one person) EXCLUDED A N N 9910853 04/24/2022 04/24/2023 PERSONALS ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE _ $2,000,000 lPOCY I I PRO-C7 I I LOC X LIJEPRODUCTS-COMP/OP AGG $2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT IEa ecddent) $1,000,000 X ANY AUTO BODILY INJURY(Per person) A OWNED AUTOS ONLY _AUTOSULED N N 9910853 04/24/2022 04/24/2023 BODILY INJURY(Per accident HIRED AUTOS ONLY NON-0WNED PROPERTY DAMAGE AUTOS ONLY (Per accident) X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $5,000,000 A EXCESS LIAB CLAIMS-MADE N N 9910854 04/24/2022 04/24/2023 AGGREGATE $5,000,000 DED I RETENTION WORKERS COMPENSATION PER STATUTE OTH- ERAND EMPLOYERS'LIABILITY Y/N ANY PROPRIETORIPARTNERIEXECUTIVE I I E.L.EACH ACCIDENT OFFICERIMEMBER EXCLUDED? N I A (Mandatory In NH) E.L DISEASE-EA EMPLOYEE If yes, a under E.L DISEASE-POUCY LIMIT DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Mdidonal Remarks Schedule,may be attached if more space Is required) RE: 1097 B STREET, ASHLAND OR 97520 CERTIFICATE HOLDER CANCELLATION 343-547-6 188 0 CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE 90 N MOUNTAIN AVE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ASHLAND,OR 97520-2014 ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD