HomeMy WebLinkAboutInsurance Certificate: Pacific Power Group, LLC DATE(MM/DD/YYYY)
ACOR" CERTIFICATE OF LIABILITY INSURANCE
7/l/2027 6/29/2026
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 Lockton Companies,LLC CONTACT
NAME:
DBA Lockton Insurance Brokers,LLC in CA PHONE FAX
CA license#OF15767 A/C Ext: A/C No
E-MAIL
500 W.Monroe,Ste.3400 ADDRESS.
Chicago 1L 60661 INSURER(S)AFFORDING COVERAGE NAIC#
(312)669-6900 midwestcertificates@lockton.com INSURER A:Starr Indemnity&Liability Company 38318
INSURED pacific Power Group,LLC INSURER B:American Lon shore Mutual Association
1573112 7215 S 228th Street INSURER C:Sentry Casualty Company 28460
Kent,WA 98032 INSURER D:Underwriters at Lloyds of London 10736
INSURER E:Admiral Insurance Company 24856
INSURER F:Beazley Insurance Company,Inc. 37540
COVERAGES CERTIFICATE NUMBER: 23606340 REVISION NUMBER: XXXXXXX
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 SUBR POLICY EFF POLICY EXP LIMITS
LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY
A X COMMERCIAL GENERAL LIABILITY Y N MASILHS00795226 7/1/2026 7/1/2027 EACH OCCURRENCE $ 1,000,000
AMAGE To RENTED ,
CLAIMS-MADE 1XI OCCUR PREM SES(E.o. rrr.'ee) $ 100 000
MED EXP(Any one person) $ 10,000
PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
X POLICY n PRO LOC PRODUCTS-COMP/OP AGG $ 2,000,000
JECT
OTHER: $
A AUTOMOBILE LIABILITY Y N 1000635932261 7/1/2026 7/1/2027 COMBINED SINGLE LIMIT $
Ea accident 2,000,000
X ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $ XXX� �
AUTOS ONLY AUTOS ONLY Per accident
$ XXXXXXX
D UMBRELLA LIAB X OCCUR Y N EMR-00001255-00 7/1/2026 7/1/2027 EACH OCCURRENCE $ 5,000,000
E X EXCESS LIAB CLAIMS-MADE UX000002752-01 7/1/2026 7/1/2027 AGGREGATE $ 51000,000
DED RETENTION$ $ XXXXXXX
WORKERS COMPENSATION PER OTH-
C AND EMPLOYERS'LIABILITY N 90-2I694-003 AOS) 7/I/2026 7/1/2027 X STATUTE ER
C ANY PROPRIETOR/PARTNER/EXECUTIVE YIN
90-21694-004�WI) 7/1/2026 7/1/2027 E.L.EACH ACCIDENT $ 11000,000
OFFICER/MEMBER EXCLUDED? ❑N N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
B USL&H N N ALMA-092622-080057-02 10/1/2024 10/1/2027 SIM Each Ace/S1M Annual Agg/
$1 M Each Employee
F Marine Excess Liability V3C8FA260101 7/1/2026 7/1/2027 S4M Each oce/$4M Annual Agg
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
The City of Ashland,its officers,agents and employees are included as additional insureds if required by written contract with respect to General Liability and Automobile
Liability per the terms and conditions of the policy.Excess Liability coverage follows form over the underlying General Liability,Automobile Liability,and Employer's
Liability if required by written contract per the terms and conditions of the policy.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
23606340 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS.
90 N Mountain Rd
Ashland OR 97520 AUTHORIZED REPRESENTATI
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