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HomeMy WebLinkAboutMichels Pacific Energy Inc. (3)ACCODO® v I� CERTIFICATE OF LIABILITY INSURANCE ll DATE (MMID) �D24 o1/22/2024 r 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 certiflcate does not confer rights to the certiflcate holder in lieu of such endorsements . PRODUCER Willis Towers Watson Midwest, Inc, C/o 26 Century Blvd P.O. Box 305191 CONTACT Willis Towers Watson Certificate Center NAME: PHONE 1-877-945-7378 FAX 1-988-467-2378 AIC No: E ADDRESS: certificates@wiIlia.com INSURERS AFFORDING COVERAGE NAIC # Nashville, TN 372305191 USA INSURERA: Greenwich Insurance Company 22322 INSURED INSURER B: XL Insurance America Inc 24554 Michels Pacific Energy, Inc. 9433 Dowcor Lane INSURERC: XL Specialty Insurance Company 37885 INSURER D: Tumwater, WA 96512 INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER! W32520456 RFVISION NIIMRFR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POl ICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPLCT 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 ADDL SUBR POLICY NUMBER POLICY EFF MWODtYYYY POLICY EXP MM/DDIYYYY LIMITS x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 3,000,000 CLAMS MADE OCCUR DAMAGE TO RENT95 PREMISES Ea occunence $ 1,000,000 MEP EXP (Any one person) $ A _ y CGD740955307 02/01/2024 02/01/2025 -PERSONAL 8ADVINJURY $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 6,000,000 PRO-JECT C LOC POLICY IR PRODUCTS - COMP/OP AGG $ 6,000,0001 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 5,000,000 BODILY INJURY [Per person) S x ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS y CAD140955401 02/01/2024 02/01/2025 BODI-YINJURY(Peracedent) $ HIRED NON -OWNED PROPERTY DAMAGE Per accdenl AUTOS ONLY AUTOS ONLY $ 8 UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 x AGGREGATE $ Sr000.000 EXCESS LIAB CLAIMSWADE US0007766ILI24A 02/01/2024 02/131/2025 DED I I RETENTIONS $ WORKERS COMPENSATION X PER OTH I AND EMPLOYERS' LIABILITY Y 1 N STATUTE ER E.L. EACH ACC DENT $ 1,000.000 C ANYPROPRIETOR/PARTNERIEXECUTIVE OFFICERIMEMBEREXCLUDED7 No NIA CWD740955107 02/01/2024 02/01/2025 E.L. DISEASE EA EMPLOYEE S 1,000.000 (Mandatory In NH) It yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE • POLICY LIM T $ 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 EmE $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 Remarks Schedule, may be 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. GCK I IrII.:A 1 r- MULL7t11% GAIVGGLLA I IUN 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 Caldwell, ID 83605 Kr�!!r•1�J ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD RR =: 25315690 BATCH 3297849