HomeMy WebLinkAboutInsurance Certificate: OBEC Consulting Engineers OP ID: SL
CERTIFICATE OF LIABILITY INSURANCE °A'03119
03/19/112 2
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 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
800-338-1391 CONTACT
701 M MARSH 888$21-3173 PAHOO No Eat; FAX No:MC.701 Market St.,Ste.1100
St.Louis,MO 63101 E-MAIL
ADDRESS:
Jeff B.Connelly PRODUCER OBEC-01
CUSTOMER ID d:
INSURER(S)AFFORDING COVERAGE NAIC d
INSURED OBEC Consulting Engineers INSURER A:Hartford Insurance Company 22357
920 Country Club Road INSURER B:
Eugene,OR 97401-2231
INSURER C:
INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 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.
INSR TYPE OF INSURANCE POLICY NUMBER MMIDD/YEYYY MM/DD UP LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,08
• X COMMERCIAL GENERAL LIABILITY 84SBWPA4035 03/20112 03/20113 PREMISES Ee occunence $ 1,000,00
CLAIMS-MADE O OCCUR MED UP(Any one person) $ 10,00
PERSONAL B ADV INJURY $ 1,000,08
PROF.LIABILITY EXCLUDED GENERAL AGGREGATE S 2,880,08
GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,08
POLICY X PRO- LOC $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 2,000,00
• X ANY AUTO 84UEGPF0127 03120/12 03/20113 (Ea accident)
BODILY INJURY(Per person) 5
ALL OWNED AUTOS
BODILY INJURY(Per accident) $
SCHEDULED AUTOS
PROPERTY DAMAGE $
HIRED AUTOS (Per accident)
NON-OWNED AUTOS $
$
X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 7,000,08
EXCESS LIAB CLAIMS-MADE AGGREGATE $ 7,000,00
A 84SBWPA4035 03/20112 03120113
DEDUCTIBLE $
- — X- 'RETEN❑ON $ --10,000 - - -$
WORKERS COMPENSATION X WCSTATU- OR
AND EMPLOYERS'LIABILITY
A ANY PROPRIETOR/PARTNER/EXECt1TIVE YIN N/A 84WBGBJ0746 03/20/12 03/20113 E.L.EACH ACCIDENT $ 1,000,08
EX
OFFICER/MEMBER CLUDEDT
(Mandatory in NH) E,L.DISEASE-EA EMPLOYEE $ 1,000,08
N es,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,08
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,It mom apace Is required)
Project:ARRA Project No.2007-17 Oak-Ann Street Section(Hersey Street
Sidewalk Reconstruction)-City o{Ashland is included as additional insured
for above coverages except WC as required by written contract
CERTIFICATE HOLDER CANCELLATION
2 �j'.l 2 ��I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
I `l/f VC V THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
CITY OF ACCORDANCE WITH THE POLICY PROVISIONS.
51 WINBURN WAY
ASHLAND,OR 975 MAR 2 3 2012 AUTHORIZED REPRESENTATNE
X"a., R. G "
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