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HomeMy WebLinkAboutInsurance Certificate: Hassell Fabrication, Inc. 711/13/2025 E(MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 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 NAME: IMA Certs Team k.p.d. Insurance, LLC PHONE FAX 1111 Gateway Loop A/c No Ext: A/C NO): Springfield OR 97477 ADODRESS: certificates@imacorp.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Trumbull Insurance Company 27120 INSURED HASSFAB01A INSURER B: SAIF Corporation 36196 Hassell Fabrication, Inc. 300 Dead Indian Memorial Rd INSURERc: Hartford Insurance Company Ashland OR 97520 INSURER D 7 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:2019381873 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY C X COMMERCIAL GENERAL LIABILITY Y 52UUNSV6CC6 6/15/2025 6/15/2026 EACH OCCURRENCE $1,000,000 CLAIMS-MADE OCCUR PREMI DAMAGE REMISES RENTED PREMISESS Ea occurrence) ccurrence) $300,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY ❑ PRO ❑ JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 X OTHER: $ A AUTOMOBILE LIABILITY 52UENOL2160 6/15/2025 6/15/2026 COMBINED SINGLE LIMIT $1,000,000 Ea accident ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION 888341 12/1/2025 12/1/2026 X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? � NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 C Property 52UUNSV6CC6 6/15/2025 6/15/2026 Special form Replacement Cost $2,500 Deductible DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers Compensation Information: Proprietors/Partners/Executive Officers/Members Excluded:subject to the policy terms and conditions. Certificate Holder and all other parties required by the contract are included as Additional Insured on the General Liability and Automobile Liability Policies,if required by written contract or agreement,subject to the policy terms and conditions. CERTIFICATE HOLDER CANCELLATION 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 20 E. Main St AUTHORIZED REPRESENTATIVE Ashland OR 97520 ;Fr 4u ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD