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HomeMy WebLinkAboutInsurance Certificate: Pape' Mahinery, Inc.co CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 02127/2024 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(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 endorsements . PRODUCER CONTACT MARSH USA LLC. 111 SW COLUMND, OR IA, S E. 500 PHONE EA0 — -_- ---- --. _ 1 taC, No) ---_ Attn: portiand.conrequest@marsh.com ADDRESS:_—_____ CN101920226•STND-GAWU•24.25 PM INSURED PAPE' MACHINERY, INC, C/O THE PAPE' GROUP, INC. PO BOX 407 EUGENE, OR 97440 14 OVERAGE NAIC N - — — �24147 NIA COVERAGES CERTIFICATF N►JMRFRr SFA-00374977q•9n RFVIRIr1N NIIMRGI?. 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. INSRDL'SUQRI —___ _ _ LTR TYPE OF INSURANCE POLICY NUMBER MMIDDNYYY MMIDDNY Y LIMITS A ! X COMMERCIAL GENERAL LIABILITY X j MWZY31610224 03101/2024 03101/2025 EACH OCCURRENCE $ 5,000,000 CLAIMS -MADE �� OCCUR `i 250,000 � _ � PREMISES$ PREMISES (Ea occurroitcej_ X CONTRACTUAL LIAB —)—PERSONAL MED EXP (Any one person) $ X PER PROJECT AGO $12M (CAP & ADV INJURY I $ 5,000,000 GEN L AGGREGATE LIMIT APPLIES PER, GENERAL AGGREGATE $ 6,000,000 PRO. POLICY C� JECT LOC j _-----_----___ —.-___ PRODUCTS - COMPIOP AGO $ 6,000,000 OTHER: i $ A AUTOMOBILE LIABILITY X j I MWTB31610124 03101/2024 03/0112025 COMBINED SINGLE LIMIT $ 6,000,000 t--- _fEe accidentT_,_—.—, — --- X ANY AUTO i i -__- BODILY INJURY (Par person) $ X X _ OWNED AUTOS ONLY X AUTOS — TO SCHEDULED�— AUTOSNON-ONED I { — -- BODILY INJURY (Per accident) � $ PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Par acadon0__- $ I $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ --------._..._._-- EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ A I WORKERS COMPENSATION MWC31610024 1 OP077ng-03/0112025 X IPER OTH AND EMPLOYERS' LIABILITY YINALL STATES EXCEPT OR —; STATUTE ER _ _ - — -- ANYPROPRIETOR)PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED7 N / A E.L. EACH ACCIDENT $ 1,000,000 (Mandatory In NH) INCLUDES STOP GAP LIABILITY E.L. DISEASE - EA EMPLOYEE! $ 1,000,000 If yos, dose The under DESCRIPTION OF OPERATIONS below ONLY FOR STATE OF WA -- ----_.___.-.---__ _..-._-._. E.L. DISEASE - POLICY LIMIT $ 1.000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If moro space Is required) City of Ashland is included as additional insured (except workers' compensation) where required by written contract. U City of Ashland Attn: Nicole Graham 20 East Main St. Ashland, OR 97520 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ACOREP L AGENCY CUSTOMER ID: CN101920226 LOC #: Portland ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED MARSH USA LLC. PAPE MACHINERY, INC. CIO THE PAPE' GROUP, INC. PO BOX 407 POLICY NUMBER EUGENE, OR 97440 CARRIER NAIL CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance WORKERS' COMPENSATION (CONTINUED): OREGON POLICY 11483762 (PAPE MATERIAL HANDLING, INC.) POLICY 11486875 (PAPE GROUP, INC.) POLICY #730660 (PAPE TRUCKS, INC,) POLICY 4731864 (PAPE TRUCK LEASING, INC.) POLICY 4938352 (PAPEMACHINERY, INC.) POLICY 11524683 (PAPE' DW, INC.) POLICY 099867 (WHITE BUTTE RANCH, LLC) INSURER: SAIF CORPORATION POLICY NUMBERr: 483762 (OR) EFFECTIVE DATE: 01/01/2024 EXPIRATION DATE: 01101/2025 WORKERS' COMPENSATION LIMIT: STATUTORY EMPLOYER'S LIABILITY LIMITS: $1,000,000 BODILY INJURY BY ACCIDENT - EACH ACCIDENT $1,000,000 BODILY INJURY BY DISEASE - EACH EMPLOYEE $1,000,000 BODILY INJURY BY DISEASE - POLICY LIMIT ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD