HomeMy WebLinkAboutInsurance Certificate: Osmose Utilities Services, Inc. AC R® CERTIFICATE OF LIABILITY INSURANCE 7E(MNVDD/YYYY)
O6/23/2025
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(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 2
certificate does not confer rights to the certificate holder In lieu of such endorsement(s). E
PRODUCER CONTACTNAME:
Aon Risk Services Central, inc. PHONE (866) 283-7122 FAX (800) 363-0105
MSC# 17385 (A/C.No.Ext): NC.No.
nBOX 1447 ADDRESS:PO SS: 2
Lincolnshire IL 60069 USA
INSURER(S)AFFORDING COVERAGE NAIC#
INSURED INSURER A: Starr indemnity & Liability company 38318
Osmose Utilities Services, Inc. INSURERB:
191 Peachtree St NE
suite 500 INSURERC:
Atlanta GA 30303 USA INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 570113538452 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. Limits shown are as requested
INSR LTp TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MWDD/YYYY POLICY EFF POLICY EXP LIMITS
X COMMERCIAL GENERAL LIABILITY '07EACH OCCURRENCE $2,000,000
CLAIMS-MADE ❑X OCCUR PREMISES Ea occurrence) S2 000,000
MED EXP(Any one person) $5,000
PERSONAL&ADV INJURY S2,000,000 U
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000
X POLICY ❑PR� LOC PRODUCTS-COMP/OPAGG S4,000,000 M
OTHER: o
n
A 1000679694251 07/01/2025 07/01/2026 COMBINED SINGLE LIMIT `)
AUTOMOBILE LIABILITY $5,000,000
AUtO-A05 ' •.
A X ANYAUTO 1000679693251 07/01/2025 07/01/2026 BODILY INJURY(Per person) C
SCHEDULED Auto-MA Z
OWNED BODILY INJURY(Per accident) d
AUTOS
AUTOS ONLY HIRED AUTOS NON-OWNED PROPERTY DAMAGE V
ONLY AUTOS ONLY Per accident
Gl
A UMBRELLALIAB H OCCUR 1000095518251 7 1 25 07/01/2026 EACH OCCURRENCE $5,000,060 V
X EXCESS LIAR CLAIMS-MADE AGGREGATE $5,000,000
DED I RETENTION
A WORKERS COMPENSATION AND 43265 7-77717025 07/01/2026 X PER STATUTE I OTH.
EMPLOYERS'LIABILITY ER
ANY PROPRIETOR/PARTNER/EXECUTIVE YIN workers Compensation (A05
A OFFICER/MEMBER EXCLUDED/ N/A 1001243266 07/01/2025 07/01/2026 E.L.EACH ACCIDENT $1,000,000
(Mandatory in NH) workers Compensation (wI) E.L.DISEASE-EA EMPLOYEE $1,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000—
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) f
The City of Ashland, Oregon, and its elected officials, officers and employees is included as Additional insured in accordance
with the policy provisions of the General Liability & Automobile Liability policies. The General Liability insurance is
primary and non-contributory over any existing insurance and limited to liability arising out of the operations of the named
insured subject to policy terms and conditions and where required by written contract. A waiver of Subrogation is granted in
favor of Certificate Holder in accordance with the policy provisions of the General Liability policy.
CERTIFICATE HOLDER CANCELLATION
b
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 _
I�IC•'UF�64r 20 East Main Street R
Ashland OR 97520 USA r —
01988-2015 ACORD CORPORATION.All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD