HomeMy WebLinkAboutInsurance Certificate: S & S Sheetmetal Inc CERTIFICATE OF LIABILITY INSURANCE FDATE{ YYYYj
03/10/200l2026
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 NAME; CLIENT CONTACT CENTER
FEDERATED MUTUAL INSURANCE COMPANY
HOME OFFICE:P.O.BOX 328 (A/C,No,Ext):888-333-4949 LAIC,No):SOT-446-4664
OWATONNA,MN 55060 AIL
ADDRESS:CLIENTCONTACTCENTER@aFEDINS.COM
INSURERS AFFORDING COVERAGE NAIC 4
INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935
INSURED INSURER a:FEDERATED RESERVE INSURANCE COMPANY 16024
S&S SHEETMETAL INC - — — — - ---"-
INSURER C:
912 ANTELOPE RD
WHITE CITY,OR 97503-1607 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:429 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 WVO MM/DDIYYYY MMIDWYYYY
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000
CLAIMS-MADE OCCUR DAMAGE
cccuErenoe ELATED PREMISES $100,000
MED EXP(Any one person) EXCLUDED
B Y N 9910853 04/24/2026 04/24/2027 PERSONAL AfVINJURY $1,000,400
GENE AGGREGATE—I,
LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
X POLICY I PE� LOC PRODUCTS 6 COMPtOP ACC $2,000,000
OTHER: L�—FF"
I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,OOD,00D
(Ea acoidenf)
JXANYAUTC BODILY INJURY(Per Person)
BOWNED AUTOS ONLY SAUIHEDULED Y N 9910853 04124/2026 04/24/2027 BODILY INJURY(Per Accident)
HIRED AUTOS ONLY O-W E� (PecRY-DAM�EaOS N A
X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $5,000,000
B EXCESSLIAB CLAIMS-MADE N N 9910854 04/24/2026 04/24/2027 AGGREGATE $5,000,000
DED I RETENTION
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY YfN PER STATUTE THER
ANY PROPRIETORIPARTNERI EXECUTIVE
El EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? N/A
(Mandatory in NH) El DISEASE EA EMPLOYEE
If yes,describe under
DESCRIPTION OF OPERATIONS below El DISEASE POLICY LIMIT
i
DESCRIPTION OF OPERATIONS f LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
SEE ATTACHED PAGE
CERTIFICATE HOLDER CANCELLATION
CITY OF ASHLAND 4290 50 E MAIN 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
O 1988-2015 ACORD CORPORATION.All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID:
LOC#:
ADDITIONAL REMARKS SCHEDULE
Page 1 of 1
AGENCY NAMEDINSURED
FEDERATED MUTUAL INSURANCE COMPANY S&S SHEETMETAL INC
912 ANTELOPE RD
POLICY NUMBER WHITE CITY,OR 97503-1607
SEE CERTIFICATE#429.0
CARRIER NAIC CODE EFFECTIVE DATE:SEE CERTIFICATE##429.0
SEE CERTIFICATE##429.0
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE
SECONDARY POLICY(S)
General Liability Y N 1851508 04/24/2026 04/24/2027 EACH OCCURRENCE $1,000,000
DMG TO RNT PREM EA OCC 4100,000
MED EXP-ANY ONE PERSON EXCLUDED
PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE $2,000,000
PRODUCTS-COMP/OP AGG $2,000,000
PROJECT: 3070 HWY 66, ASHLAND OR 97520
THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS,
LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU ENDORSEMENT FOR GENERAL
LIABILITY.
THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED BY CONTRACT
ENDORSEMENT FOR BUSINESS AUTO LIABILITY.
ACORD 101 (2008101) O 2008 ACORD CORPORATION.All rights reserved.
The ACORD name and logo are registered marks of ACORD