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HomeMy WebLinkAbout413403 OTAK INC - INSURANCE CERTIFICATE (14)ACoROr CERTIFICATE OF LIABILITY INSURANCE DATE (M8/2017 Y) 2/ 18/2017 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 CONTACT Peggy MacMillan NAME: JD Fulwiler & Co. Insurance, Inc. FIC N Ext : (503)293-8325 FAX No): (503)293-5418 5727 SW Macadam Ave E-MAIL pmacmillan@jdfulwiler.com ADDRESS: INSURERS) AFFORDING COVERAGE NAIC # PO Box 69508 Portland OR 97239 INSURER A: Travelers Indemnity Cc of CT 25682 INSURED INSURER B : Travelers Indemnity Co of Am 25666 Loris and Associates Inc an Otak Division INSURER C : Zurich American Insurance Cc INSURER D : 100 Superior Plaza Way, Ste 220 INSURER E : INSURER F : Superior CO 80027 COVERAGES CERTIFICATE NUMBER: 18/19 Loris GEN USE 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. 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 INSD WVD POLICY NUMBER POLICY EFF (MMlDDlYYYY) POLICY Y EXP (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE F_x] OCCUR PREMISES Ea occurrence $ 300,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 A 6805H242469 01/01/2018 01/01/2019 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO LOC 7 JECTFX PRODUCTS - COMP/OPAGG $ 2,000,000POLICY Employee Benefits $ 1,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS BA1502P892 01/01/2018 01/01/2019 BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY IX Towing s X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 AGGREGATE s 10,000,000 B EXCESS LIAB CLAIMS -MADE CUP5C857081 01/01/2018 01/01/2019 DED I X RETENTION $ 10,000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA WC9696241 01/01/2018 01/01/2019 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000DESCRIPTION $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) All operations of the named insured are subject to policy terms, conditions and exclusions. ceKlo- 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. 215 N. Mason St., 2nd Floor AUTHORIZED REPRESENTATIVE P.O. Box 580 Fort Collins CO 80522 fir` © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Additional Named Insureds Other Named Insureds Day CPM LLC, an OTAK Division HLB Otak Inc., an Oregon Corporation Loris and Associates Inc, an OTAK Division OTAK Architects Inc, a Washington Corporation Otak Architects Inc., an Oregon Corporation Otak Engineering, Inc., an Oregon Corporation Otak International (Caymen Islands) Otak Nevada, LLC, an Oregon Limited Liability Co Otak, Inc. 401K Employee Savings Plan Otak, Inc., a Colorado Corporation Otak, Inc., an Washington Corporation Otak Inc OFAPPINF (02/2007) COPYRIGHT 2007, AMS SERVICES INC