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HomeMy WebLinkAboutInsurance Certificate: Altec Industries, Inc.ACORO DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 05/23/2024 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 grid ette Piazza McGriff Insurance Services, LLC NAME: g 2000 International Park Drive AICNNo Ext: 1'600 476-2211 FA No): Suite 600 E-MAIL bridgette.piazza�mcgriff.com Birmingham, AL 35243 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC S INSURER A :Lexington Insurance Company 19437 INSURED INSURER B :Hartford Fire Insurance Company 19682 Altec Industries, Inc. 1450 N 1st. Street INSURER C :AIG Specialty Insurance Company 26883 Dixon, CA 95620 INSURER D :Trumbull Insurance ComDanY 27120 INSURER E :Hartford Accident and Indemnity Comoanv 1 22357 rnVFRAnFC CFRTIFICATF NIIMRFR-C.IPFRWG.1 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 LTR TYPE OF INSURANCE ADDL U R POLICY NUMBER EFF MM/DDN YY MY WDD/YY P LIMITS A X COMMERCIAL GENERAL LIABILITY 013136094 06/01/2024 06/01/2025 EACH OCCURRENCE $ 5,000,000 CLAIMS -MADE � OCCUR PREMISES Ea occurrence $ 3,000,000 MED EXP (Any one person) $ N/A PERSONAL 8 ADV INJURY $ 5,000,000 X GEII AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,000 X POLICY PRO ❑ LOC JECT PRODUCTS - COMP/OP AGG $ 10,000,000 $ OTHER: B AUTOMOBILE LIABILITY 21 CSES27903 06/01/2024 06/01/2025 COMBINED SINGLE LIMIT Ea accident 5,000,000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY X BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ C ELLA LIAR X OCCUR 18576786 06/01/2024 06/01/2025 EACH OCCURRENCE $ 10,000,000 4UMBR AGGREGATE $ 10,000,000 XCESCLAIMS-MADE ED RETENTION $ $ D E WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 21WNS27900 (AOS) 21XWES27902(AL,M0,NC) 06/01/2024 06/01/2025 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N/A E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below $ $ DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Service, Maintenance, or Repair The City of Ashland. Oregon, its officers, agents and employees are additional insured under General Liability and Automobile Liability on a primary and non-contributory basis as required by written contract. See cancellation endorsement form attached. (`FQTIFIf ATF 1I II cANrFI I ATInN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland AUTHORIZED REPRESENTATIVE 20 East Main Street 019-t—) Ashland, OR 97520 Page 1 of / V 1966-21 1b AL;II GUHYVHAI IL)N. All rlgni5 reserveO. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 21 CSE S27903 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Farm apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Wl-o Is An Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement effective Named insured ALTEC, INC. Name of person(s) or Organization(s): Countersigned by SCHEDULE (Authorized Representative) Any person or organization that you are required to include as an additional insured on this coverage form in a written contract or agreement that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period. (If no entry appears above, information required to complete this endorsement will be shcwn in the Declarations as applicable to the endorsement ) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 Page 2 of 7 CJPFRWGJ Altec, Inc. Policy No. 21CSES27903 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S) This policy is subject to the following additional Conditions: If this policy is cancelled by the Company, other than for nonpayment of premium, notice of such cancellation will be provided to the certificate holder(s) with mailing addresses on file with the agent of record. Such notice will be provided within 30 days of the Company's receipt of certificate holder(s) information from the agent of record. If notice is mailed, proof of mailing to the last known mailing address of the certificate holder(s) Form IH 03 10 06 11 on file with the agent of record will be sufficient proof of notice. Any notification rights provided by this endorsement apply only to active certificate holder(s) who were issued a certificate of insurance applicable to this policy's term. Failure to provide such notice to the certificate holder(s) will not amend or extend the date the cancellation becomes effective, nor will it negate cancellation of the policy. Failure to send notice shall impose no liability of any kind upon the Company or its agents or representatives. Page 1 of 1 C 2011, The Hartford Page 3 of 7 CJPFRWGJ ENDORSEMENT This endorsement, effective 12:01 A.M., Forms a part of Policy No.: 013136094 Issued to: Altec, Inc. Attn: Mark Bertovic By: LEXINGTON INSURANCE COMPANY ADDITIONAL INSURED REQUIRED BY WRITTEN CONTRACT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY POLICY A. Section 11 — Who Is An Insured is amended to include any person or organization you are required to include as an additional insured on this policy by a written contract or written agreement in effect during this policy period and executed prior to the "occurrence" of the "bodily injury" or "property damage." B. The insurance provided to the above described additional insured under this endorsement is limited as follows: 1. COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE (Section I - Coverages) only. 2. The person or organization is only an additional insured with respect to liability arising out of "your work" or "your product" for that additional insured. 3. In the event that the Limits of Insurance provided by this policy exceed the Limits of Insurance required by the written contract or written agreement, the insurance provided by this endorsement shall be limited to the Limits of Insurance required by the written contract or written agreement. This endorsement shall not increase the Limits of Insurance stated in the Declarations under Item 3. Limits of Insurance pertaining to the coverage provided herein. 4. The insurance provided to such an additional insured does not apply to "bodily injury" or "property damage" arising out of an architect's, engineer's or surveyor's rendering of or failure to render any professional services including: i The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders, or drawings and specifications; and ii Supervisory, inspection, architectural or engineering activities. 5. This insurance does not apply to "bodily injury" or "property damage" arising out of "your work" or "your product" included in the "products -completed operations hazard" unless you are required to provide such coverage by written contract or written agreement. 6. Any coverage provided by this endorsement to an additional insured shall be excess over any other valid and collectible insurance available to the additional insured whether primary, excess, contingent or on any other basis unless a written contract or written agreement specifically requires that this insurance apply on a primary and non-contributory basis. Manuscript Form Page 1 of 2 Page 4 of 7 CJPFRWGJ C. In accordance with the terms and conditions of the policy and as more fully explained in the policy, as soon as practicable, each additional insured must give us prompt notice of any "occurrence" which may result in a claim, forward all legal papers to us, cooperate in the defense of any actions, and otherwise comply with all of the policy's terms and conditions. All other terms and conditions of the policy remain the same. Authorized Representative Manuscript Form Page 2 of 2 Page 5 of 7 CJPFRWGJ ENDORSEMENT # 038 This endorsement, effective 12:01 AM Forms a part of policy no.: 013136094 Issued to: ALTEC, INC. ATTN: MARK BERTOVIC By: LEXINGTON INSURANCE COMPANY ADVICE OF CANCELLATION TO ENTITIES OTHER THAN THE NAMED INSURED LIMITED TO E-MAIL NOTIFICATION This policy is amended as follows: In the event that the Insurer cancels this policy for any reason other then non payment of premium, and 1. The cancellation effective date is prior to this policy's expiration date; 2. The First Named Insured is under an existing contractual obligation to notify a certificate holder when this policy is canceled (hereinafter, the "Certificate Holders)"); and -has provided to the Insurer, either directly or through its broker of record, the email address of the contact at such entity, and the Insurer received this information after the First Named Insured receives notice of cancellation of this policy and prior to this policy's cancellation effective date, via an electronic spreadsheet that is acceptable to the Insurer, the Insurer will provide advice of cancellation (the 'Advice-) via e-mail to such Certificate Holders. Proof of the Insurer emailing the Advice, using the information provided by the First Named Insured, will serve as proof that the Insurer has fully satisfied its obligations under this endorsement. This endorsement does not affect, in any way, coverage provided under this policy or the cancellation of thls policy or the effective date thereof, nor shall this endorsement invest any rights in any entity not insured under this policy. The following Definitions apply to this endorsement: 1. First Named Insured means the Named Insured shown on the Declarations Page of this policy. 2. Insurer means the insurance company shown in the header on the Declarations Page of this policy. All other terms and conditions remain unchanged. D/4vj- Bxw� Authorized Representative OR Countersignature (in states where applicable) LEXD00O21 LX0404 Page 6 of 7 CJPFRWGJ Altec, Inc. Policy No. 21 WNS27900 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S) This policy is subject to the following additional Conditions: If this policy is cancelled by the Company, other than for nonpayment of premium, notice of such cancellation will be provided to the certificate holder(s) with mailing addresses on file with the agent of record. Such notice will be provided within 30 days of the Company's receipt of certificate holder(s) information from the agent of record. If notice is mailed, proof of mailing to the last known mailing address of the certificate holder(s) Form IH 03 10 06 11 on file with the agent of record will be sufficient proof of notice. Any notification rights provided by this endorsement apply only to active certificate holder(s) who were issued a certificate of insurance applicable to this policy's term. Failure to provide such notice to the certificate holder(s) will not amend or extend the date the cancellation becomes effective, nor will it negate cancellation of the policy. Failure to send notice shall impose no liability of any kind upon the Company or its agents or representatives. Page 1 of 1 © 2011, The Hartford Page 7 of 7 CJPFRWGJ