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HomeMy WebLinkAboutOLSON COI 23.12.31SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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 THISCERTIFICATE 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED?(Mandatory in NH) DESCRIPTION OF OPERATIONS belowIf yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIREDAUTOS ONLY 12/30/2022 Alliant Insurance Services,Inc.101 Park Ave 14th FlNewYorkNY10178 Olivia Villasana Olivia.Villasana@alliant.com License#:0C36861 Steadfast Insurance Company 26387 VCMHOLD-01 Zurich American Insurance Comp 16535VCMHoldco,LLC1800Avenueofthe Stars,Suite 1450LosAngelesCA90067 Navigators Specialty Insurance 36056 AXIS Surplus Insurance Company 26620 413214703 A X 1,000,000 X 1,000,000 25,000 1,000,000 2,000,000 X Y Y GPL-0539290-00 12/31/2022 12/31/2023 2,000,000 B 2,000,000 X Y Y BAP-9702723-00 12/31/2022 12/31/2023 CD X 5,000,000 X Y CH22EXC921841ICP-001-001063546-01 12/31/202212/31/2022 Y 12/31/202312/31/2023 5,000,000 X 0 B Stop Gap WC 0958232-00 12/31/2022 12/31/2023 Limit $1,000,000 Prospect Construction is shown as additional insured on the General Liability,Auto Liability,and Umbrella Liability policies as required by written contractsubjecttopolicyterms,conditions and exclusions.A Waiver of Subrogation applies in favor of the certificate holder on the General Liability,Auto Liability,andUmbrellaLiabilitypolicies. Prospect Construction11623rdStSEPuyallupWA98372 Named Insured Schedule: VCM Holdco, LLC Vac One Acquisition, Inc. Texas ReExcavation, LC Cyclone Services, LLC Vac One Leasing, LLC Kantex Management, LLC Kantex Industries, Inc. Kantex Subsurface, Inc. Olson Brothers Pro-Vac, LLC dba Pro-Vac Pro-Vac, LLC Pro-Vac Investors, Inc. Best Parking Lot Cleaning, LLC Pro-Vac Holdings, Inc. Peninsula Pro-Vac Corp.