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HomeMy WebLinkAboutInsurance Certificate: Liquid Engineering Corp. (2) LIQUENG-02 RDYER '4Cf CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) I`.-------- 3/18/2021 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). PRODUCER CONTACT Renee Dyer Billings Office (NC,PHONE Eat);(406)238-1986 I FAX No): PayneWest Insurance,Inc. EMAIL P.O.Box 30638 AI SS:rdyer@paynewest.com Billings,MT 59107-0638 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Homeland Insurance Company of New York 34452 INSURED INSURER B:Atlantic Specialty Insurance Company 27154 Liquid Engineering Corporation INSURER C:Montana State Fund 15819 P.O.Box 80230 INSURER D:Zurich American Insurance Company 16535 Billings,MT 59108-0230 y(, INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER IMM/DD/YYYY1 (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X 7930021220006 5/1/2020 5/1/2021 PREM SES(Ea oNcaurr nce) $ 50,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JECTPRO- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY (EO acciden SINGLE LIMIT $ 1,000,000 X ANY AUTO _ 7930021210006 5/1/2020 5/1/2021 BODILYINJURY(Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY _ AUTOS ONLY (Per accident) $ $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE 7930021230006 5/1/2020 5/1/2021 AGGREGATE $ 5,000,000 DED X RETENTION$ 0 $ C WORKERS COMPENSATION PERTUTE ETH AND EMPLOYERS'LIABILITY Y/N 034802595 3/31/2021 3/31/2022 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ /M OFFICEREMBER EXCLUDED? N/A - 1,000;000- (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes.describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ D Workers Compensation WC959746710 3/31/2021 3/31/2022 OtherStates SeeBelow 1,000,000 A Professional/Polluti 7930021220006 5/1/2020 5/1/2021 Per Claim/Aggregate 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) *Workers Comp Information for Policy WC959746709 Coverage A States: AK,FL,NY Coverage A Statutory Employers Liability Limits for Policy WC959746709: Each Accident: $1,000,000/Disease-Each Employee: $1,000,000/Disease-Policy Limit: $1,000,000 Part C Other States Insurance-All States except ND,OH,WA,WY,MT and those States listed in Part 3 A See next page for additional policy information. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Ashland Water Department ACCORDANCE WITH THE POLICY PROVISIONS. 90 N.Mountain Avenue Ashland,OR 97520 AUTHORIZED TH� �DRREPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD