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HomeMy WebLinkAboutInsurance Certificate: Hannon Enterprises dba Overhead Door Co. of Rogue Valley A CERTIFICATE OF LIABILITY INSURANCE • DATE(MM/DDIYYYY) 02/12/2021 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). .. - d, PRODUCERCONTACT Dena Leong • NAME: Redwoods.Leavitt Insurance Agency PHONE (855)285-5690FAX (541)479-2669 (A/C,No,Ext): - (A/C,No): 700 E Main.Street . E-MAIL' dena-leong@leavitt.com - -- ADDRESS: Suite 101 INSURERS)AFFORDING COVERAGE .. • NAIC# Medford OR 97504 INSURERA: Midwest Family Mutual Insurance Company 23574 INSURED • INSURER B: SAIF Corporation 36196 Hannon Enterprises Inc, INSURER C: DBA Overhead Door Co.of the Rogue Valley INSURER D: PO Box 8193 INSURER E Medford OR 97501 INSURER F: COVERAGES CERTIFICATE NUMBER: 21-22 Work Comp Renew 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 INSD WVD POLICY NUMBER (MM/DDIYYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY • EACH OCCURRENCE $ 1,000;009 DAMAGE TO RENTED • CLAIMS-MADE X OCCUR . . PREMISES(Ea occurrence) $ 500,000 MED EXP(Any one person) $ 5,000 A CPOR0560121972 04/29/2020 04/29/2021- PERSONAL&ADVINJURY'• ' $ 1,000,000- • GEN'LAGGREGATE LIMITAPPLIES PER: _GENERGGREGATE $ 2000,000' ALA , POLICY X RO n LOC 000020 , OTHER: _Employee Benefits $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ - A OWNED SCHEDULED CPOR0560121972 04/29/2020 04/29/2021 BODILY INJURY(Per accident) $ AUTOS ONLY X AUTOS __ X HIRED NON-OWNED . PROPERTY DAMAGE AUTOS ONLY X AUTOS ONLY (Per accident) $ — Uninsured motorist $ 1,000,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LIAB CLAIMS-MADE CPOR0560121972 04/29/2020 04/29/2021 AGGREGATE $ 2,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION X STA UTE 0TH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000, ._ B OFFICER/MEMBER EXCLUDED? N N/A 631720 02/01/2021 02/01/2022 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate updated to reflect Workers Comp Renewal for 21-22 Waiver Subrogation per WC000313 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE i THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Ashland Public Works Dept ' ACCORDANCE WITH THE POLICY PROVISIONS. 90 N.Mountain Ave. AUTHORIZED REPRESENTATIVE , Ashland OR 97520 c -11I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) •The ACORD name and logo are registered marks of ACORD www.saif.com saiht . Carrier no: 20001 Endorsement no: WC000313 (Ed. 430B)' SAIF policy: 631720 Hannon Enterprises Inc Waiver of Our Right to Recover from Others Endorsement We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Description: All Operations Contractor name: Persons and/or organizations who, with the insured-employer are parties to a construction agreement as defined in ORS 30.140. This endorsement does not alter the rights of an injured worker to pursue recovery from another party or SAIF to receive a statutory share of recoveries by an injured worker, even from the party listed in the schedule. The premium charge for this endorsement is based on one (1) percent of your manual premium. Effective date: February 01, 2021 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. Countersigned December 28, 2020 at Salem, Oregon WC000313 Kerry Barnett (Ed. 430B) President and Chief Executive Officer 400 High Street SE Salem,OR 97312 P:800.285.8525 F:503.373.8020 Pol_PC1_E430B