HomeMy WebLinkAboutInsurance Certificate: Altec Industries, Inc. '�` CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDlYrrrl
05/28J2026
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THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
a 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 NOAME: Bridgette Piazza
McGriff,a Marsh&McLennan Agency LLC Company PHONE
2000 International Park Drive Ext.1-800-476-2211 FVG No):
E-MAILML brid ette. iazza marshmma.com
Suite 600 ADDRESS: 9 p
Birmingham,AL 35243
INSURERS AFFORDING COVERAGE NAIC#
INSURER A:Lexington Insurance Company 19437
INSURED INSURER B:Hartford Fire Insurance Company 19682
Aitec Industries,Inc. INSURER C:AIG Specialty Insurance Company 26883
1450 N 1st.Street
Dixon,CA 95620 INSURER D:Hartford Accident and Indemnity Company 22357
INSURER E: Hartford Casualty Insurance Company 29424
INSURER F:
COVERAGES CERTIFICATE NUMBER:9HLXHEPK 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 INCLUSIVE OF AMOUNTS REQUESTED BY THE CERTIFICATE
HOLDER AND MAY NOT REFLECT POLICY LIMIT AMOUNTS IN EXCESS OF THOSE REQUESTED. *Not Applicable in WY
INSR TYPE OF INSURANCE ADOL SUBR POLICY NUMBER MM10DY1YYYY MMIDDY EXP LIMITS
LTR
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 5,000 000
A
013136094 06/01/2026 06/01/2027 DAMAGE r0 ENTER
CLAIMS-MADE � OCCUR PREMISES Ea occurrence $ 3,000,000
X MED EXP(Any one person) $ N/A
PERSONAL&ADV INJURY $ 5,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,000
X POLICY a PRO [] LOC PRODUCTS-COMP/OP AGG $ 10,000,000
JECT
OTHER:
COMBINED SINGLE LIMIT $ 5,000,000
B AUTOMOBILE LIABILITY
21CSES27903 06J0112026 06J01J2027 Ea accident
X ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED X BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
X AUTOS ONLY X AUTOS ONLY Per accident
C X UMBRELLA LIAB X OCCUR 033074396 06/01/2026 06/01/2027 EACH OCCURRENCE $ 10,000,000
EXCESS LIAR CLAIMS-MADE AGGREGATE $ 10,000,000
DED I I RETENTION$ $
D WORKERS COMPENSATION 21WNS27900(AOS) 06/01/2026 06101/2027 X STATUTE I DER'
E AND EMPLOYERS'LIABILITY Y 1 N
ANYPROPRIETORtPARTNERJEXECUTIVE N 1 A 21XWES27902(AL,MO,NC) E.L.EACH ACCIDENT $ 1,000,000
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
If as,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
RE:Service,Maintenance,or Repair
The City of Ashland,Oregon,its officers,agents and employees are additional insured under General Liability and Automobile Liability on a primary and non-contributory
basis as required by written contract.See cancellation endorsement form attached.
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 East Main Street AUTHORIZED REPRESENTATIVE
Ashland,OR 97520
ACORD 25(2025/12) O 1988-2025 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Page 1 of 7
POLICY NUMBER
COMMERCIAL AUTO
CA 20 48 02 99
THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY,
DESIGNATED INSURED
This endorscrnent modifies insurance provided under the following,
BUSINESS AUTO COVERAGE FORM
GARAGE: COVERAGE FORM
MOTOR CARRIER COVIERAGE FORM
TRUCKERS COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage FDrm apply unless modified
by this endorsement-
This endorsement identifies person(s) or organization(s) who are "insureds" under the Wt a Is An Insured Provision of
the Coverage Form This endorsement does not after coverage provided in the Coverage Form
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated
below.
Endorsement effective
I Named insured Countersigned by
7J T'-`(,', I
(Authorized Representative)
SCHEDULE
----------------
ame of persons) or Crganizabons):11�I I - i t 1=,-1 t7)-.j a, in --4jjr ' jr7at
-y
e zt.
(.If no entry appears above, Information required to complete this endorsement will be shcwn in the Declarations as
applicable,to the endorsement i
Each person or organization 0iown in the Schedule is an "insured" for Liability Cove age, but only to the extent that
person or oi�ganizatron qualifies as an "insured" Linder the Who Is An Insured Provisicri contained in Section 11 of the
Coverage Form.
CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page I of I
Page 2 of 7 9HLXHEPK
Altec, Inc.
d,
c4 Policy No. 21CSES27903
O
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S)
This policy is subject to the following additional on file with the agent of record will be sufficient
Conditions: proof of notice. provided by this
If this policy is cancelled by the Company, other Any notification rights
than for nonpayment of premium, notice of such endorsement apply only to active certificate
cancellation will be provided to the certificate holder(s) who were issued a certificate of
holder(s) with mailing addresses on file with the insurance applicable to this policy's term.
agent of record. Such notice will be provided Failure to provide such notice to the certificate
within 30 days of the Company's receipt of holder(s) will not amend or extend the date the
certificate holder(s) information from the agent of cancellation becomes effective, nor will it negate
record, cancellation of the policy. Failure to send notice
If notice is mailed, proof of mailing to the last shall impose no liability of any kind upon the
known mailing address of the certificate holder(s) Company or its agents or representatives
Form 1H 03 10 06 11 0 2011,The Hartford Page I of I
9HLXHEPK
Page 3 of 7
ENDORSEMENT.,
This endorsement, effective 12:01 A.M.,
Forms a part of Policy No.: 013136094
Issued to: Altec, Inc. Attn: Mark Bertovic
By: LEXINGTON INSURANCE COMPANY
ADDITIONAL INSURED REQUIRED BY WRITTEN CONTRACT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY POLICY
A. Section 11 - Who Is An Insured is amended to include any person or organization you are
required to include as an additional insured on this Policy by a written contract or written
agreement in effect during this Policy period and executed prior to the "Occurrence" of the
"bodily injury" or "property damage,"
B. The insurance provided to the above described additional insured under this endorsement is
limited as follows:
1. COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE (Section I - Coverages) only.
2. The person or organization is only an additional insured with respect to liability arising out
of "your work" or "Your product" for that additional insured.
3. In the event that the Limits of Insurance provided by this Policy exceed the Limits of
Insurance required by the written contract or written agreement, the insurance provided by
this endorsement shall be limited to the Limits of Insurance required by the written
contract or written agreement. This endorsement shall not increase the Limits of
Insurance stated in the Declarations under Item 3. Limits of Insurance pertaining to the
coverage provided herein,
4. The insurance provided to such an additional insured does not apply to 'bodily injury" or
"property damage" arising out of an architect's, engineer's or surveyor's rendering of or
failure to render any professional services including:
I The preparing, approving or failing to prepare or approve maps, shop drawings,
opinions, reports, surveys, field orders, change orders, or drawings and specifications;
and
!I Supervisory, inspection, architectural or engineering activities.
5. This insurance does not apply to "bodily injury" or "property damage" arising out of "Your
work" or "your product" included in the "products-completed operations hazard" unless
you are required to Provide such coverage by written contract or written agreement.
6. Any coverage provided by this endorsement to an additional insured shall be excess over
any other valid and collectible insurance available to the additional insured whether
primary, excess, contingent or on any other basis unless a written contract or written
agreement specifically requires that this insurance apply on a primary and non-contributory
basis.
Manuscript Form Page 1 of 2
Page 4 of 7
nul V,-.1
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C. In accordance with the terms and conditions of the policy and as more fully explained in the
policy, as soon as practicable, each additional insured must give us prompt notice of any
"occurrence" which may result in a claim, forward all legal papers to us, cooperate in the
defense of any actions, and otherwise comply with all of the policy's terms and conditions.
All other terms and conditions of the policy remain the same.
Authorized Representative
Manuscript For Page 2 of 2
Page 5 of 7 9HLXHEPK
ENDORSEMENT # 038
This endorsement, effective 12:01 AM
Forms apart of policy no.: 013136094
Issued to: ALTEC, INC.
ATTN: MARK BERTOVIC
By: LEXINGTON INSURANCE COMPANY
ADVICE OF CANCELLATION TO ENTITIES OTHER THAN THE NAMED INSURED UMITED TO E-MAIL
NOTIFICATION
This policy is amended as follows:
In the event that the Insurer cancels this policy for any reason other than non payment of premium, and
1, The cancellation effective date is prior to this policy's expiration date;
2. The First Named Insured is under an existing contractual obligation to notify a certificate
holder when this policy is canceled thereinafter, the "Certificate Holderts)'); and,has provided
to the Insurer, either directly or through its broker of record, the email address of the contact
at such entity,
and the Insurer received this information after the First Named Insured receives notice of
cancellation of this policy and prior to this policy's cancellation effective data, via an electronic
spreadsheet that is acceptable to the Insurer,
the Insurer will provide advice of cancellation (the 'Advice') via e-mail to such Certificate Holders.
Proof of the Insurer emailing the Advice, using the Information provided by the First Named Insured, will
serve as proof that the Insurer has fully satisfied its obligations under this endorsement.
This endorsement does not affect, in any way, coverage provided under this policy or the cancellation of
this policy or the effective date thereof, nor shall this endorsement Invest any rights in any entity not
insured under this policy.
The following Definitions apply to this endorse ment-
1. First Named Insured means the Named Insured shown on the Declarations Page of this policy.
2. Insurer means the insurance company shown in the header on the Declarations Page of this
policy.
All other terms and conditions remain unchanged.
A
Authorized Representative OR
Countersignature fin states he applicable)
LEXD00O21
LX0404
Page 6 of 7 9HLXHEPK
Altec, Inc.
,6
Policy No. 21WNS27900
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THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S)
This policy is subject to the following additional on file with the agent of record will be sufficient
Conditions: proof of notice.
If this policy is cancelled by the Company, other Any notification rights provided by this
than for nonpayment of premium, notice of such endorsement apply only to active certificate
cancellation will be provided to the certificate holder(s) who were issued a certificate of
holder(s) with mailing addresses on file with the insurance applicable to this policy's term.
agent of record. Such notice will be provided Failure to provide such notice to the certificate
within 30 days of the Company's receipt of holder(s) will not amend or extend the date the
certificate holder(s) information from the agent of cancellation becomes effective, nor will it negate
record. cancellation of the policy. Failure to send notice
If notice is mailed, proof of mailing to the last shall impose no liability of any kind upon the
known mailing address of the certificate holder(s) Company or its agents or representatives.
or 1H 03 10 06 11 Page I of I
0 2011, The Hartford
Page 7 of 7 9HLXHEPK