HomeMy WebLinkAboutInsurance Certificate: Engineered Monitoring Solutions (5)
.----,
,,\CORD' CERTIFICATE OF LIABILITY INSURANCE I om (MMlDDIYYYY)
11/3012010
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 pollcy(ies) muat be endorsed. If SUBROGATION IS WAIVED, subject to
the tenna and conditions of the policy, certain pollcle. may require an endolllement. A statement on this cert/flcate doe. not confer rights to the
certificate holder In lieu of such endorsemenl(S).
PRODUCER Phone: 503-365-7001 Fax: 503-365-7354 CONTACT SLATER & ASSOCIATES INSURANCE
NAME"
MID V ALLEY GENERAL AGENCY LLC I ;~_NNE, FoIl, 1503-624-0466 1~~N01: 1503-624-0846
4305 RIVER ROAD N ",.." (first name) @Slaterinsurance.com
KEIZER OR 97303 PRODUCER 19476
CU5T M RI .
INSURER(S) AFFORDING COVERAGE HAle.
INSURED INSURER A , SCOTTSDALE INSURANCE COMPANY 41297
ENGINEERED MONITORING SOLUTIONS LLC
617 N MAIN ST INSURERS:
NEWBERG OR 97132 INSURERC :
INSURER 0:
INSURERE :
INSURERF:
COVERAGES CERTIFICATE NUMBER: 47201
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. NOlWlTHSTANDING 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,
c,~, , .me e"nw" ".v, '0' ,~, .,,,.
INSR TYPE OF INSURANCE "'0' 1= POUCY NUMBER POLlCYEFF POLlCYEXP UMITS
m 'N' ""'" ""'"
A GENERAL LIABILITY CPS1104202 12/03110 12/03111 EACH OCCURRENCE S 1,0,00,,000
Ix COMMERCIAL GENERAL LIABILITY ~~~~~,,~HTED _, S 1,00,,000
I CLAIMS-MADE IXl OCCUR MED. EXP (Any one person) S 5,,000
PERSONAL & AOV INJURY $ 1,0,00,,000
I- 2,0,00,,000
GENERAL AGGREGATE S
I- 2,0,00,,000
n'l AGGREGATE LIMIT APn~ PER: PRODUCTS - COMPfOP AGG S
,r I PRO-
POLICY .'';';;T LOC S
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
I- (ElIsccident)
I- ANY AUTO BODtL Y INJURY (Per person)
S
I- ALL OWNED AUTOS BODILY INJURY (Per IIccident)
S
I- SCHEDULED AUTOS PROPERTY DAMAGE
HIRED AUTOS Perllccidllntl S
I-
NON-OWNED AUTOS S
l- S
I- UMBRELLA ,~. HOCCUR EACH OCCURRENCE I.
EXCESS ,~. CLAIMS-MADE AGGREGATE I.
I- DEDUCTIBLE I,
RETENTION $ S
WORKERS COMPENSATION I ~gRST~~'t I 10TH $
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETORIPARTNERlEXECUTIVE 0 EL EACH ACCIDENT I.
OFFICERlMEMBER EXCLUDED? N,^ I,
(M."doot<>ryl"NH) E.L DISEASE-EA EMPLOYEE
Ilyel,dlSClibeundlf EL. DISEASE-POLICY LIMIT
DESCRIPTION OF OPERATIONS below $
DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Rem,r1ts Schedule,lf mo,.. 'pace Is requl,..dj
CITY OF ASHLAND IS INCLUDED AS ADDITIONAL INSURED PER CG2010(7104)
CERTIFICATE HOLDER
CANCELLATION
CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN
90 N MOUNTAIN AVE ACCORDANCE WITH THE POLICY PROVISIONS.
ASHLAND, OR 97520
AUTHORIZED REPRESENTATIVE
Attention: KARl OLSON MID VALLEY GENERAL AGENCY LtC \-l ~. ~';(J_'
Herman R Deiss
ACORD 25 (2009/09)
@1988-2009ACORDCORPORATION, All rights reserved,
The ACORD name and logo are registered marks of ACORD
.' .
.
POLICY NUMBER: CPS1104202
EINGINEERED MONITORING SOLUTIONS, LLC
COMMERCIAL GENERAL LIABILITY
CG 20 10 07 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Location/sl Of Covered Operations
Or Oraanization/sl:
CITY OF ASHLAND
90 N MOUNTAIN AVE
ASHLAND, OR 97520
ATTN:KARIOLSON
POLICY PERIOD: 12-03-2010 TO 12-03-2011
Information reauired to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II - Who Is An Insured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury", "property
damage" or "personal and advertising injury"
caused, in whole or in part, by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your
behalf;
in the performance of your ongoing operations for
the additional insured(s) at the location(s) desig-
nated above,
B. With respect to the insurance afforded to these
additional insureds, the following additional exclu-
sions apply:
This insurance does not apply to "bodily injury" or
"property damage" occurring after:
1. All work, including materials, parts or equip-
ment furnished in connection with such work,
on the project (other than service, maintenance
or repairs) to be performed by or on behalf of
the additional insured(s) at the location of the
covered operations has been completed; or
2. That portion of "your work" out of which the
injury or damage arises has been put to its in-
tended use by any person or organization other
than another contractor or subcontractor en-
gaged in performing operations for a principal
as a part of the same project.
Page 1 of 1
o
CG 20 10 07 04
@ ISO Properties, Inc., 2004