HomeMy WebLinkAboutInsurance Certificate: Countryside Electric Inc. A Q® DATE(MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 06/14/2025
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 endorsement(s).
PRODUCER NAME: CLIENT CONTACT CENTER
FEDERATED MUTUAL INSURANCE COMPANY --pilaw V
HOME OFFICE:P.O.BOX 328 IA/C,No,Ext):888-333-4949 IA/C,NO:507-446-4664
OWATONNA,MN 55060 E-MAIL
ADDRESS:CLI ENTCONTACTCE NTE R®FEDI N S.COM
INSURERS AFFORDING COVERAGE NAIC#
INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935
INSURED INSURER B:
COUNTRYSIDE ELECTRIC INC. INSURER C:
PO BOX 395
TURNER,OR 97392-0395 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:9 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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD MMfDD/YYYY MMIDDIYYVY
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000
CLAIMS-MADE FXI..CUR DAMAGE
ccurrence TO RENTED PREMISES $100,000
Ee o
X BUSINESS OWNER'S LIABILITY NIED EXP(Any one person)
A N N 1902752 08/05/2025 08/05/2026 PERSONAL&ADV INJURY $1,000,000
OEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 000 000
X POLICY �E�T ❑LOC PRODUCTS&COMP/OP ACC $2,000,000
OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ;1,000,000
(Ea accidenq
JANYAUTO BODILY INJURY(Per Person)
AOWNED AUTOS ONLY SAUTHEDDULED N N 1902753 08/052025 08/05/2026 BODILY INJURY(Per Accident)
HIRED AUTOS ONLY NON-OWNED PROPERTY DAMAGE
AUTOS ONLY Per Accident
X UMBRELLA LAB X OCCUR EACH OCCURRENCE S2,000,000
A EXCESSLIAB CLAIMS-MADE N N 1902754 08/052025 08/05/2026 AGGREGATE $2,000,000
DIED I RETENTION
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY YfN PER STATUTE THEIR
ANY PROPRIETOR/PARTNERI EXECUTIVE E.L EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? N/A
(Mandatory in NH E.L DISEASE fA EMPLOYEE
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L DISEASE POLICY LIMIT
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
CERTIFICATE HOLDER CANCELLATION
CITY OF SHLAND 9 0
20 E MAINN ST SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
ASHLAND,OR 97520-1814 BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE/ n
O 1988-2015 ACORD CORPORATION.All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
444-698-5 9
#B W N DH BS BH000-OE-0044
#XWXW0021 XXXXXXX5#
CITY OF ASHLAND
20 E Main St
Ashland, OR 97520-1814