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HomeMy WebLinkAboutNORTHWEST SIGNAL SUPPLY INC - INSURANCE CERTIFICATE (3)k.. R CERTIFICATE OF LIABILITY INSURANCE �� D/5/2 DD"YYY' 3/5/2013 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 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 endorsements . PRODUCER M Fulwller S Co. Insurance, Inc. 5727 SW Macadam Ave PO Box 69508 Portland OR 97239 CONTACT Sofia Janjgava PHONE (503)293-8325 FAX No, (503)293-5418 EalaL .sjanjgava@jdfulwiler. com INSURERS AFFORDING COVERAGE RAIC 0 INSURER A Libert NW Ohio 4074 INSURED Northwest Signal Supply, Inc. dba NWS Traffic Engineering 12965 SW Herman Road Tualatin OR 97062 INSURERB:WOSt American Insurance Cc INSURER C Admiral Insurance Company INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:CL133520045 REVISION NIIMRFR- 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 LTR TYPE OF INSURANCE ADDADDL SUuK POLICY NUMBER POLICY EFF M POLICY EXP MM D LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 PREMISES pence $ 100,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X BK01450552307 /1/2013 /1/2014 MED EXP one Person) $ 10,000 PERSONAL S ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY 71 PRO- LOC $ AUTOMOBILE LIABILITY COMBINEDDi SINGLE UMIT (Ea accidenB 11000,000 X BODILY INJURY (Per person) $ ANY AUTO AALLOOWNED SCHEDULED OS W1450552307 /1/2013 /1/2014 BODILY INJURY (Per accident) $ NON -OWNED MIRED AUTOS AUTOS PROPERTY DAMAGE Per $ Uninsured motorist combined $ 11000,00 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIMB CLAIMS -MADE DED I I RETENTION 8 I $ WORKERS COMPENSATION WCSTATU- OTH- AND EMPLOYERS' LIABILITY Y I NLIM ANY PROPRIETOWPARTNEREXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N / A FIR E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatary In NH) H yas describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ C Professional Liability E000000139015 /1/2013 /1/2014 Each Claim $ 11000,000 Dad. $5000 Aggregate $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Ramarks Schedule, Hmom space Is required) City of Fort Collins, its officers, agents and employees are additional insureds per form CG8862. CERTIFICATE HOLDER rANrFI I ATInM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. P 0 Box 580 AUTHORIZED REPRESENTATIVE Fort Collins, CO 80524 Diane Durnin/SOFIA ACORD 25 (2010105) INS025 (201005).01 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 88 62 12 08 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - BLANKET VENDORS This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART Section 11 - Who Is An Insured is amended to include as, an additional insured any person(s) or organiza- tions) (referred to below as vendor) whom you have agreed to add as an additional insured in a written contract or written, agreement,but only with respect to "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business, subject to the following additional exclusions: 1. The insurance afforded the vendor does not apply to: a. "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have In the absence of the contract or agree- ment; b. Any express warranty unauthorized by you; c. Any physical or chemical change In the product made Intentionally by the vendor; d. Repackaging, except when unpacked solely for the purpose of Inspection, demonstration, test- ing or the substitution of parts under Instructions from the manufacturer, and then repackaged in the original container; e. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; f. Demonstration, installation, servicing or repair operations; except such operations performed at the vendor's premises in connection with the sale of the product; g. Products which, after distribution or sale by you, have been labeled or relabeled or used as.3. container; part or Ingredient of any other thing or substance by or for the vendor, or It. "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does notapply to: (t) The exceptions contained in Subparagraphs d. or f.; or (2) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, In connection with the distribution or sale of -the products. 2. This insurance does not apply to any insured person or organization, from whom you have ac- quired such products, or any ingredient, part or container, entering into, accompanying or contain- ing such products. CG 88 62 12 08 Includes copyrighted material of ISO Properties, Inc., with Its permission. Page 1 of 1