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Insurance - Pape Material Handling, Inc. - 2020-03-17iia 7R '77►` CERTIFICATE OF LIABILITY INSURANCE oATE(MMro0/YYY1r] 43!17/2020 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 MARSH USA INC. 111 SW COLUMBIA, STE. 500 PORTLAND, OR 97201 Attn: Amy Shafer 503-2484857; amy.shafer@marsh.com CONTACT NAME: PHONE AIC No)* E-MAILDR A GCLAIMS-MADE X I COMMERCIAL GENERAL LIABILITY � OCCUR TqONTRACTUALH LIAB INSURERS AFFORDING COVERA NAIC # INSURER A: National Union Fire Insurance Company 19445 CN101920226-.-GAWU: 20-21 PM INSURED PAPE MATERIAL HANDLING, INC. INSURER B : Insurance Company Of The State Of PA 19429 INSURER C : NIA NIA C/O THE PAPE GROUP, INC. PO BOX 407 EUGENE, OR 97440 INSURER D : National Union Fire Ins Co Pittsburgh PA 19445 INSURER E :NIA NIA INSURER F: Navigators Insurarice.Company 42307 GOVLKAUE5 CERTIFICATE NUMBER: SEA -003652558-02 RI=VISInfJ w IfuIRr-R• 1 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 ADDL UBR POLICY NUMBER POLICY EFF IMWDDIYYYYI POLICY EXP IMWDDIYYYYiLIMITS of Marsh USA Inc. A GCLAIMS-MADE X I COMMERCIAL GENERAL LIABILITY � OCCUR TqONTRACTUALH LIAB GL 5180113 XSC30000974301 080877638 03/01/2020 03/01/2020 03101/2020 03/0112021 03/0112021 03/0112021 EACH OCCURRENCE $ 5,000,000 AMA TO RENTED PREMISES Ea occurrence $ 250,000 MED EXP (Any oneperson) $ 25,000 X PER PROJECT AGG $2M PERSONAL & ADV INJURY $ 5,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY a JEa LOC GENERAL AGGREGATE $ 5,0KOW PRODUCTS - COMPIOP AGG $ 5,000,000 $ OTHER: A F AUTOMOBILE LIABILITY X ANY AUTO CA 2961543 NY20FXR8379531V 03/01/2020 03/01/2020 03/01/2021 03101/2021 Es acB�.IINED SINGLE LIMIT $ 5,000,000 BODILY INJURY (Per person) $ X OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident ( ) $ X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE $ Per accident UMBRELLA LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB DED RETENTION $ $ B D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? N (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WC 80756260 (AOS) WC 80756261 (CA} 'Includes Stop Ga Liability P P 'Only for State WA' 0310112020 0310112020 03101/2021 03141/2021 X PER I I OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Hired Auto Physical Damage CA 2961543 03/01/2020 Per Vehicle Limit 250,000 n Deductibles - CompJCoA. 2501500 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Costa Mesa Sanitary District, its directors, officials, officers, employees, agents, and volunteers are included as additional insured for General Liability where required by written agreement or contract. This insurance is primary and non-contributory if agreed to by written contract executed prior to loss. CERTIFICATE HOLDER CANCF[ I ATInN Costa Mesa Sanitary District SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 290 Pauladno Avenue Costa Mesa, CA 92626 -3)g qij�,, �41 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. , AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Raymond M. Schneider 4%w,.sa. -9, AA."Wke 41988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD AC'OR" AGENCY CUSTOMER ID: CN101920226 LOC #: Portland ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED MARSH USA INC, PAPE MATERIAL HANDLING, INC. C/O THE PAPE GROUP, INC. PO BOX 407 POLICY NUMBER EUGENE, OR 97440 CARRIER NAIC CODE EFFECTIVE DATE: r+vvI I 1%w111r` n[--nuwRna THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance INSURERS AFFORDING COVERAGE/NAIC# INSURER G: Endurance American Insurance Company (10641) INSURER H: Lexington Insurance Company (19437) INSURER I: NIA (NIA) Workers' Compensation - Oregon (continued): Policy #483762 (Pape' Material Handling, Inc.) Policy #486875 (Pape' Group, Inc.) Policy #730660 (Pape' Trucks, Inc.) Policy #731864 (Pape' Truck Leasing, Inc.) Policy #938352 (Pape' Machinery, Inc.) Policy #524683 (Pape' DW, Inc_) Policy #999867 (White Butte Ranch, LLC) Insurer: SAIF Corporation Effective Date: 01/01/2020 Expiration Date: 01!01/2021 Workers' Compensation Limit: Statutory Employer's Liability limits: $1,000,000. Bodily Injury by Accident - Each Accident t $1,000,000 Bodily Injury by Disease - Each Employee ! $1,000,000 Bodily Injury by Disease - Policy Limit, This certificate supersedes evidence of insurance previously provided by Yale/Chase Equipment and Services Inc., due to the acquisition, effective 3/20/2020, by Pape' Material Handling, Inc. Ativtrcu 1u1 J1uUUIUI I O 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: GL 518-01-13 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 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) Or Organization(s) Location(s) Of Covered Operations Any person or organization whom you become Per the written contract or agreement. obligated to include as an additional insured as a result of any written contract or agreement you have entered into that requires such additional insured coverage, Information required 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) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment 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 intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 9. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement applicable Limits of Declarations. shall not increase the Insurance shown in the Page 2 of 2 0 Insurance Services Office, Inc., 2012 CG 20 10 04 13 POLICY NUMBER: GL 518-01-13 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations _ Any person or organization whom you become Per the written contract or agreement obligated to include as an additional insured as a result of any written contract or agreement you have entered into that requires such additional insured coverage. I 3 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 - 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" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insu- rance shown in the Declarations; 2. If coverage provided to the additional whichever is less. insured is required by a contract or agree- This endorsement shall not increase the appli- ment, the insurance afforded to such addi- cable Limits of Insurance shown in the Decla- tional insured will not be broader than that rations. CG 20 37 04 13 * Insurance Services Office, Inc., 2012 Page 1 of 1 I"I 0000831 SP 0140-CO,1-P00831-1 Costa Mesa Sanitary District 290 Paularino Avenue Costa Mesa, CA 92626