HomeMy WebLinkAboutInsurance Certificate: Utility Financial Solutions, LLC DATE(MMIDD/YYYY)
AC"" CERTIFICATE OF LIABILITY INSURANCE
05/07/2025
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 certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT Certs@PCIAonline.com
NAME:
Professional Concepts Insurance Agency,Inc. pAH/cNr o Ext: (800)969-4041 a/c,No): (800)969-4081
1127 South Old US Highway 23 E-MAIL Certs@PCIAonline.com
ADDRESS:
INSURER(S)AFFORDING COVERAGE NAIC#
Brighton MI 48114-9861 INSURERA: MASSACHUSETTS BAY INSURANCE COMPANY 22306
INSURED INSURERB: THE HANOVERAMERICAN INSURANCE COMPANY 36064
Utility Financial Solutions,LLC INSURER C: General Security Indemnity Company of Arizona 20559
185 Sun Meadow Court INSURER D:
INSURER E
Holland MI 49424 INSURER F:
COVERAGES CERTIFICATE NUMBER: 25-26All 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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 POLICY EFF POLICY EXP
LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
CLAIMS-MADE FX OCCUR PREM SDAMAGES Ea oNcurDreme $
MED EXP(Any one person) $ 10,000
A Y ODHD573735 04/30/2025 04/30/2026 PERSONAL&ADV INJURY $ 2,000,000
GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 4,000,000
JECT LOC PRODUCTS-COMP/OP AGG $POLICY El PRO 4'000'000P1
OTHER: PDLL $ 300,000
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 2,000,000
Ea accident
ANYAUTO BODILY INJURY(Per person) $
A OWNED SCHEDULED Y ODHD573735 04/30/2025 04/30/2026 BODILY INJURY(Pe r accide nt) $
AUTOS ONLY AUTOS
X HIRED �/ NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY /� AUTOS ONLY Per accident
X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000
A EXCESS LAB CLAIMS-MADE ODHD573735 04/30/2025 04/30/2026 AGGREGATE $ 2,000,000
DED I I RETENTION $ $
WORKERS COMPENSATION X STATUTE EORH
AND EMPLOYERS'LIABI LI TY Y/N 1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
B OFFICER/MEMBER EXCLUDED? N/A WZHD189193 04/30/2025 04/30/2026
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
If yes,describe under 1,000,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
Professional Liability
C C55288-00464-23-03 04/30/2025 04/30/2026 Per Claim $ 2,000,000
Ann Aggregate $ 2,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
Project: Financial Consulting Services.
City of Ashland,Oregon,and its elected officials,officers and employees are considered additional insured's with respects to general and auto liability
coverage as long as required within a written contract.Waiver of subrogation in favor of certificate holder and additional insured's as long as required within a
written contract.Coverage is considered primary and non-contributory on the general liability coverage.30 day written notice provided to certificate holder
and additional insured's for cancellation of coverages listed.10 day notice for nonpayment of listed policies.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS.
90 N.Mountain Ave.
AUTHORIZED REPRESENTATIVE /� /Ja�t/ /�
Ashland OR 97520 _(/t i,nsaKa _
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