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HomeMy WebLinkAboutMichels Pacific Energy Inc. (2)ATE ACCM LY® CERTIFICATE OF LIABILITY INSURANCE D01/22/2024 ) 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 certificpte'holder in lieu of such endorsements . PRODUCER "" t• NAM:CONTACT Willis Towers Watson Certificate Center Willis Towers Watson Midwest, Inc. PHONE 1-877=945=7378 FAX 1-888-467-2378 flair_ N_,rz& _ _ _ {AIC, Nol: c/o 26 Century Blvd DR � 3in' 1 � E-MAIL P.O. Box 305191 f '"L ADD certificatea@willie.com - Nashville, TN 312305191 USA INSURER S) AFFORDING COVE RAGE NAIC0 INSURERA: Greenwich Insurance Company 22322 INSURED INSURER B : XL insurance America Inc 24554 Michals Pacific Energy, Inc. ' 9433 Dowcor Lane INSURER C: �+ Specialty insurance Company 37885 Tw water, WA 98512 INSURER 0 : INSURER E: COVFRAGFS CFRTIFiCATF NLIMRFR- W32520456 RFVISION 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 DL ADPOLICY SUER POLICY NUMBER EFF MMIDDIYYYY POLICY EXP MMIDDfYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 3,000,000 CLAIMS -MAN a OCCUR PREMISES Ea occurrence $ 1,000,000 MEP EXP (Any one person) s A 7 COD740955307 02/01/2024 02/01/2025 PERSONAL BADVINJURY $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 6,000,000 POLICY [g] jE 0 LOC PRODUCTS - COMPIOP AGG $ 6,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 5,000,000 X BODILY INJURY (Per person) s ANY AU70 A OWNED SCHEDULED AUTOS ONLY AUTOS Y CAD740955407 02/01/2024 02/01/2025 BODILY INJURY (Per accident) s HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPER ZeccdenlIIAMAGE Per $ B UMBRELLA LIAB %1 OCCUR EACH OCCURRENCE $ 5,000,000 X AGGREGATE $ 5,000,000 EXCESS CLAIMS•MADE US0007766ILI24A 02/01/2024 02/01/2025 DED RETENTIONS $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOWPARTNERIEXECUTIVE OFFICERIMEMBEREXCLUDED7 No (Mandatory in NH) NIA CWD740955107 02/01/2024 02/01/2025 X PER OTH- STATUTE ER E L EACH ACCIDENT $ 1,000,000 EL DISEASE EAEMPLOYEE $ 11000,000 If Yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE -POLICY LIMIT $ 1, 000 , 000 C Workers Compensation - WI CWR740955207 02/01/2024 02/01/2025 E.L. Each Accident $1,000,000 and Employers Liability E.L. Disease -Each Enq $1,000,000 Work Comp: Per Statute E.L. Disease-Pol Lmt $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remafks Schedule, maybe attached if more space is required) City of Caldwell is an Additional Insured with respect to the General Liability and Auto Liability coverages and the work performed by the Named Insured when required by written contract, agreement or permit executed prior to loss. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Caldwell AUTHORIZED REPRESENTATIVE 411 Blaine Street /f'0 /% Caldwell , iD 83605 4�!!d1`!?- w ©1983-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD xk :tz: 25315690 aws--n: 3297849