HomeMy WebLinkAboutInsurance Certificate: American Industrial Door LLC (2) ACC CERTIFICATE OF LIABILITY INSURANCE DAT06/23/20 6YY)
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 terns 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 A(A/C, Ext}:888 333 4949 IA/G,No}:507 446 4664
HOME OFFICE:P.O.BOX 328
OWATONNA,MN 55060 ADDRESS:CLIENTCONTACTCENTER®FEDINS.COM
INSURERS AFFORDING COVERAGE NAIC#
INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935
INSURED INSURER B:
AMERICAN INDUSTRIAL DOOR,LLC INSURER C:
6142 CRATER LAKE AVE
CENTRAL POINT,OR 97502-9414 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:27 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.
rA
TYPE flF INSURANCE ADDLSUBR POLICY NUMBER EFFPOUCYEXLIMITS
INSR WVD MMlDDIYVYY MMIDD/YYYYRCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000
AMAGE TO ENTED PREMISES $100,000
AIMS•MADE OCCUR (Ea occurrencaMED EXP(Any one person) EXCLUDED
Y N 9841942 07/06/2026 07/06/2027ERSONAL&ADVINJURY $1,000,000
GE REGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2 000,000
X POLICY Edo- ❑LOC PRODUCTS&COMPIOP ACC $2,000,000
OTHER:
AUTOMOBILE LIABILITY JEa.ccdengSINGLE LIMIT $1,D00,000
X ANYAUTO BODILY INJURY(Per Person)
A OWNED AUTOS ONLY SCHEDULED Y N 9941842 07/06/2026 07/06/2027 BODILY INJURY(Per Accident)
AUTOS
HIRED AUTOS ONLY NON-OWNED (PP OPAERia DAMAGE
AUTOS ONLY
X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $5,000,000
A EXCESSLIAB CLAIMS-MADE Y N 9841843 07/06/2026 07106/2027 AGGREGATE $5,000,000
DED I RETENTION
ANY PROPRIETORIPARTNERI EXECUTIVE PER STATUTE I THER
OFFICERIMEMBER EXCLUDED?
(Mandatory in NH) E.L EACH ACCIDENT
I1 yes,describe raider NIA '.. .- .-.
DESCRIPTION OF OPERATIONS below E.L DISEASE fA EMPLOYEE
E.L DISEASE-POLICY LIMIT
DESCRIPTION OF OPERATIONS/LOCATIONS i VEHICLES IACORD 101,Additional Remarks Schedule,may be attached If more space is required)
SEE ATTACHED PAGE
CERTIFICATE HOLDER CANCELLATION
CITY OF ASH LAND 270 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
20 E MAIN ST
ASHLAND,OR 97520-1814 BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
O 19M-2015 ACORD CORPORATION.All rights reserved.
ACORD 25(2016103) 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 AMERICAN INDUSTRIAL DOOR,LLC
6142 CRATER LAKE AVE
POLICY NUMBER CENTRAL POINT,OR 97502-9414
SEE CERTIFICATE##27.0
CARRIER NAIL CODE EFFECTIVE DATE:SEE CERTIFICATE##27.0
SEE CERTIFICATE##27.0
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE
SUBJECT TO THE TERMS AND CONDITIONS OF THE POLICY, ADDITIONAL INSUREDS ALSO INCLUDES CITY OF ASHLAND, OREGON, ALONG
WITH ITS ELECTED OFFICIALS, OFFICERS, AND EMPLOYEES
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.
INSURANCE PROVIDED BY THE GENERAL LIABILITY COVERAGE IS PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE SUBJECT TO
THE CONDITIONS OF THE PRIMARY AND NONCONTRIBUTORY CLAUSE- OTHER INSURANCE CONDITION.
INSURANCE PROVIDED BY THE BUSINESS AUTO LIABILITY IS PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE SUBJECT TO
THE CONDITIONS OF THE PRIMARY AND NONCONTRIBUTORY CLAUSE- OTHER INSURANCE CONDITION.
COMMERCIAL UMBRELLA FOLLOWS FORM ACCORDING TO THE TERMS, CONDITIONS, AND ENDORSEMENTS FOUND IN THE COMMERCIAL
UMBRELLA POLICY.
ACORD 101(2008/01) }2008 ACORD CORPORATION.All rights reserved.
The ACORD name and logo are registered marks of ACORD
COMMERCIAL AUTO
CA 04 49 11 16
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY AND NONCONTRIBUTORY -
OTHER INSURANCE CONDITION
This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless
modified by the endorsement.
A. The following is added to the Other Insurance B. The following is added to the Other Insurance
Condition in the Business Auto Coverage Form Condition in the Auto Dealers Coverage Form and
and the Other Insurance - Primary And Excess supersedes any provision to the contrary:
Insurance Provisions in the Motor Carrier This Coverage Form's Covered Autos Liability
Coverage Form and supersedes any provision to Coverage and General Liability Coverages are
the contrary: primary to and will not seek contribution from any
This Coverage Form's Covered Autos Liability other insurance available to an "insured" under
Coverage is primary to and will not seek your policy provided that:1. Such "insured" is a Named Insured under
contribution from any other insurance available to such other insurance; and
an "insured" under your policy provided that:
1. Such "insured" is a Named Insured under 2• You have agreed in writing in a contract or
agreement that this insurance would be
such other insurance; and primary, and would not seek contribution from
2. You have agreed in writing in a contract or any other insurance available to such
agreement that this insurance would be "insured'.
primary and would not seek contribution from
any other insurance available to such
"insured".
O Insurance Services Office, Inc., 2016 Page 1 of 1
CA 04 49 11 16 Policy Number: 9841842 Transaction Effective Date: 07/06/2026
CHANGES THE POLICY. R��E ��» �CA����
�Mk� .
ADDITIONAL INSURED BY CONTRACT ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE PART `
With respect to coverage provided by this endoruennmnt, the provisions of the Coverage Form apply un|ona
modified by the endorsement. �
A. WHO ISAN INSURED for"bodily injury" and "property
damage" liability io amended t» include:
Any penan» or organization other than a joint venture, for which you have *y.=e. .y written con
tract tu
procure bodily injury or property damage "auto" liability insurance arising out of operation of aoovered� r`this additional does not apply to:
auto"with your Huwe»e
c °autm" This exception d»»e
(1) The owner oranyone else from whom you hire or borro� a�x/vereu"auto" . own
not apply if the covered "outo" isa "trui|er" connected toxcovered a You own.
of his or her
(2) Your "employee" if the covered "auto" is owned by that "employee" or m nnemnb e
houaoho|d' h i working in a business of selling, servicing,
(3) Sonneoneuuingacovarad "outo" vvhi|ahaora � is auioyuure.
i parking ^outoe" un|aaethatbumna f You any a
repairing, pa " Partners (if you are a partnership). members (\
�Q Anyone other than your "employees", pa of their "ennp\oyomm" while moving
liability company), or u lessee or borrower or any .
propertyto or a covered "auto". or u member (if you
'. are u limited liability
company) for
a
(5) A partner (if you are a partnership),
covered "auto" owned by him or her or member of his m her household.
B. The coverage extended to any additional insured by this endorsement is limited to, and subject to all henna,
d xo|uaionooftho �overag� PmrthowhichthiuenUorummnen/ /uutt"^..=".
conditions, and e .
th t of the written
udditiun, coverage shall not exceed the terms and conditions that are required by e �r�nu
agreement bz add any insured, orhm \neunsnnm�pnooura .
� C. The limits of insurance applicable to such insurance mb aU be t
he lesser of the limits required by the
agreement between the parties, or the limits provided oy this policy.
afforded to any person or organization an an insured under this
D. Additional exclusions. The inauranc� .
endorsement does not apply: vvithsuohI �nsonororganization;
1 To "|omn" which occurs priortothe date ofyour contractperson
that would not be an insured
' t of oo\o negligence of any person or organization
�. To "loss" arising out I
except for this endorsement. rented
"auto" when the lessor or h\d or her agent takes possession of the
3. To "\osa" for any leased or leased or rented "auto" or the policy period ends, whichever occurs' first.
/
�
|
`
'
Inc. �uok�n.
material of no vvK K� pm""
Includes copyrighted ' office,
' Effective Dute' 0y/O8/2028
COMMERCIAL GENERAL LIABILITY
CG 20 01 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY AND NONCONTRIBUTORY -
OTHER INSURANCE CONDITION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
The following is added to the Other Insurance (2) You have agreed in writing in a contract
Condition and supersedes any provision to the or agreement that this insurance would be
contrary: primary and would not seek contribution
from any other insurance available to the
Primary And Noncontributory Insurance additional insured.
This insurance is primary to and will not seek
contribution from any other insurance available to
an additional insured under your policy provided
that:
(1) The additional insured is a Named Insured
under such other insurance; and
0 Insurance Services Office, Inc., 2018 Page 1 of 1
CG 20 01 12 19 Policy Number: 9841842 Transaction Effective Date: 07/06/2026
COMMERCIAL GENERAL LIABILITY
CG 20 33 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - AUTOMATIC STATUS WHEN
REQUIRED IN A WRITTEN CONSTRUCTION
AGREEMENT WITH YOU
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Section 11 - Who Is An Insured is amended to B. With respect to the insurance afforded to these
include as an additional insured any person or additional insureds, the following additional
organization for whom you are performing exclusions apply:
operations when you and such person or This insurance does not apply to:
organization have agreed in writing in a contract 1. "Bodily injury", "property damage" or
or agreement that such person or organization be "personal and advertising injury" arising out of
added as an additional insured on your policy. the rendering of, or the failure to render, any
Such person or organization is an additional professional architectural, engineering or
insured only with respect to liability for "bodily surveying services, including:
injury", "property damage" or "personal and a. The 'preparing, approving, or failing to
advertising injury" caused, in whole or in park, by: prepare or approve, maps, shop drawings,
1. Your acts or omissions; or opinions, reports, surveys, field orders,
2. The acts or omissions of those acting on your change orders or drawings and
behalf; specifications; or
in the performance of your ongoing operations for b. Supervisory, inspection, architectural or
the additional insured. engineering activities.
However, the insurance afforded to such This exclusion applies even if the claims
additional insured: against any insured allege negligence or other
1. Only applies to the extent permitted by law; wrongdoing in the supervision, hiring,
and employment, training or monitoring of others
by that` insured, if the "occurrence" which
2. Will not be broader than that which you are caused, the "bodily injury" or "property
required by the contract or agreement to damage" or the offense which caused the
provide for such additional insured. "personal and advertising injury", involved the
A person's or organization's status as an rendering of or the failure to render any
additional insured under this endorsement ends professional architectural, engineering or
when your operations for that additional insured surveying services.
are completed.
O Insurance Services Office, Inc., 2018 Page 1 of 2
CG 20 33 12 19 Policy Number: 9841842 Transaction Effective Date: 07/06/2026
2. "Bodily injury" or dunnage" C. With respect to the insurance afforded toth
occurring after.- these
additional inoureds, the following is added to
m' All work, including materials, parts or Section III '��mm�s0fInsurance:
="
equipment furnished in connection with The most we will pay on behalf ofthe additional
such wnrk, on the project (other than insured is the amount ofinounonoc �
oonvice, maintenance or repairs) to be 1 Required by the contract
P*norrn«d by or on behalf cfthe additional ' ra or agreement you
----- insured(s) at the location of the covered have entered into with the additional insured;
operations has been completed; or or
----- b' That portion of "your work" out of which 2~ Available under the applicable limits of
the injury or damage uriom» has been pot insurance;
to its intended use by any person or whichever ialess. �
organization other than another contractor This endorsement shall not increase the �
or subcontractor engaged in performing applicable limits ofinsurance
operations for a principal as a part ofthe '
same project.
�
Page 2 of 2 @ Insurance Services Office, Inc., 2018
CG 20 33 121S Policy Number: Q841842 Transaction Effective Date: 07/06/2028 �