HomeMy WebLinkAboutInsurance Certificate: Potelco, Inc. DATE(MM/DD/YYYY)
A`C>R" CERTIFICATE OF LIABILITY INSURANCE
0513012026
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 INSURER,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
Marsh USA LLC NAME:
4400 Comerica Bank Tower A/N No. Fuc.No
1717 Main Street E-MAIL
Dallas,TX 75201 aDOREss:
INSURERS AFFORDING COVERAGE NAIC#
CN103l22494--002-G2A2_ 9231 INSURER A: Old Re uNic Insurance Company 24147
INSURED Potelco,Inc. INSURER B: ACE Propeqy and CasuaU Insurance Company 20699
A quanta Services Company INSURER C:
14103 Stewart Rd. INSURER D:
Sumner,WA 98390
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: HOU-004306503-02 REVISION NUMBER: 1
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.
ILTR TYPE OF INSURANCE ADDL SU D POLICY NUMBER POLIC MIDD EFF POLICY EXP
M/DD LIMITS
A X COMMERCIAL,GENERAL LIABILITY Y MWZY 313093 26 06/01/2026 06/01/2027 EACH OCCURRENCE S 5,000,000
A CLAIMS-MADE X❑ OCCUR MWZX 313095 26 06/0112026 06/01/2027 PREMISES(Ea oc urrence) $ 1,000,000
MED EXP(Anyone person) $ EXCLUDED
PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000
X POLICY PICOT- LOC PRODUCTS-COMFJOP AGG $ 5,000,000
OTHER: $
A AUTOMOBILELIABILITY Y MWTS-313092-26 0610112026 0610112027 COMBINED SINGLE LIMIT $ 5,000,000
Ea accident
A X ANY AUTO MWZX 313091 26 0610T12026 OV0112C27 BODILY INJURY(Per person) S
X OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $
HIRED NON-OWNED PROPERTY DAMAGE
X AUTOS ONLY X AUTOS ONLY Per accident) S
$
B X UMBRELLA LIAR X OCCUR XEU G27972032 011 06/0112026 06/0112027 EACH OCCURRENCE S 5,000,000
I EXCESS LIAR CLAIMS-MADE AGGREGATE $ 5,00000
DED RETENTION$ $
A WORKERS COMPENSATION MWC31309426 06101/2026 06/01/2027 X I
STATUTE ERH
AND EMPLOYERS'LIABILITY
ANYPROPRIETOR/PARTNER/EXECUTIVE YIN
N E.L.EACH ACCIDENT $ 1,000,000
OFFICERIMEMBEREXCLUDED? 7 NIA
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000
If yes,describe under 1,60D,DD0
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required)
Re:All Operations General Liability And Auto Liability Policies Include The City Of Ashland,Oregon,And Its Elected officials,Officers And Employees As An Additional
Insured When Required By Written Contract But Only As Respects Liability Arising Out Of Named insured's Work For Additional€nsured.
CERTIFICATE HOLDER CANCELLATION
The City Of Ashland,Oregon SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Attn:Karl Ann Olson THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
90 N.Mountain Ave. ACCORDANCE WITH THE POLICY PROVISIONS.
Ashland,OR 97520
AUTHORIZED REPRESENTATIVE
01988-2016 ACORD CORPORATION. All rights reserved.
ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD