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HomeMy WebLinkAboutInsurance Certificate: Pacific Paving Inc ncorzo® CERTIFICATE OF LIABILITY INSURANCE °A�`MMm°""Y" 3/19/2012 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(les) 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 NONE: Susan Wilson, AAI, AIC Beecher Carlson Insurance Agency ILLC 541)772-1111 1 MAC,ft),(541)772-3785 707 Murphy Rd .susan.Wilson @beechercazlson.com INSURERS)AFFORDING COVERAGE NAIC IF Medford OR 97504 INSURERA:Travelers Property Casualty Co 25674 INSURED INSURERS:Charter Oak Fire Insurance Co 25615 Pacific Paving Inc INSURER C:Iadesnnity Company of CA PO Box 2370 INSURERD: INSUREE: White City OR 97503 :Naas :F: COVERAGES CERTIFICATE NUMBER:CL1231913704 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE Sls POLICY NUMBER MMIIDYEFF MMUDYEXP LIMITS JIM LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIALGENERALLOBILITV PREMISES(Es oaunence E 300,000 A 7 CLAIMS-MADE aOCCUR 4TC0526D8417TIL12 /20/2012 /20/2013 MED EXP(My One person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE If 2,000,000 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO LOC $ JECT AUTOMOBILE LIABILITY n LIMIT 1,000,000 ANY AUTO BODILY INJURY(Per p..) $ B ALL OMED SCHEDULED aAS26DS41712CNS /20/2012 /20/2013 AUTOS AUTOS BODILY INJURY(Per eaitlem) E X NON-OMED PROPERTY DAMAGE $ HIRED AUTOS AUTOS PerecadeM X Metliral enle $ 5,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE E EXCESS LIAR CLAMS-MADE AGGREGATE $ OLD I I RE ENTNry$ E WORHERSCOMPENSAMON 1AC STATU- 0TH.LIMIT R AND EMPLOYERS'LVIBILITY YIN R ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICEWMENBER EXCLUDED? "IA (Manclatory In NH) EL DISEASE-EA EMPLOYE E 11 yes,desmhe umer DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT E C BOLI Bond (Statutory) 785448C /14/2012 /14/2013 Limn: $30,000 Prevailing Wage DESCMP ION OF OPERATIONS'LOCATIONS/VEHICLES (Attach ACORD 101,Addlional Remarks SchedW e,If more apace to repul red) General Liability policy includes Blanket Additional Insured coverage and Primary/Non-contributory provision per endorsement CGD2460805 (attached) . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ^�„ ,r E EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland, it EFL HIVk/ CORDANCE WITH THE POLICY PROVISIONS. officers S employee 20 East Main Street A RIZED REPRESENTATIVE Ashland, OR 97520 MAR 2 3 2012 'lson, AAI, AIC/SU c t�• /'/i�• - ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and to o are to istered marks of ACORD COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED— (Section II) is amended c) The insurance provided to the additional in- to include any person or organization that you sured does not apply to "bodily injury" or agree in a "written contract requiring insurance" "property damage" caused by "your work" to include as an additional insured on this Cover- and included in the "products-completed op- age Part, but: erations hazard" unless the "written contract a) Only with respect to liability for"bodily injury", requiring insurance" specifically requires you "property damage"or"personal injury"; and to provide such coverage for that additional insured, and then the insurance provided to b) If, and only to the extent that, the injury or the additional insured applies only to such damage is caused by acts or omissions of "bodily injury" or "property damage" that oc- you or your subcontractor in the performance curs before the end of the period of time for of "your work" to which the "written contract which the "written contract requiring insur- requiring insurance" applies. The person or ance" requires you to provide such coverage organization does not qualify as an additional or the end of the policy period, whichever is insured with respect to the independent acts earlier. or omissions of such person or organization. 3. The insurance provided to the additional insured 2. The insurance provided to the additional insured by this endorsement is excess over any valid and by this endorsement is limited as follows: collectible "other insurance", whether primary, a) In the event that the Limits of Insurance of excess, contingent or on any other basis, that is this Coverage Part shown in the Declarations available to the additional insured for a loss we exceed the limits of liability required by the cover under this endorsement. However, if the 'Written contract requiring insurance", the in- "written contract requiring insurance" specifically surance provided to the additional insured requires that this insurance apply on a primary shall be limited to the limits of liability re- basis or a primary arid nun-uuntributury basis, quired by that "written contract requiring in- this insurance is primary to "other insurance" surance". This endorsement shall not in- available to the additional insured which covers crease the limits of insurance described in that person or organization as a named insured Section III—Limits Of Insurance. for such loss, and we will not share with that b "other insurance". But the insurance provided to ) The insurance provided to the additional in- the additional insured by this endorsement still is sured does not apply to "bodily injury", "prop- excess over any valid and collectible "other in- erty damage" or "personal injury" arising out surance", whether primary, excess, contingent or of the rendering of, or failure to render, any on any other basis, that is available to the addi- professional architectural, engineering or sur- tional insured when that person or organization is veying services, Including: an additional insured under such "other insur- I. The preparing, approving, or failing to ance". prepare or approve, maps, shop draw- 4. As a condition of coverage provided to the ings, opinions, reports, surveys, field or- additional insured by this endorsement: ders or change orders, or the preparing, approving, or failing to prepare or ap- a) The additional insured must give us written prove, drawings and specifications; and notice as Bonn as praMirahle of nn "nccur- II. Supervisory, inspection, architectural or rence" or an offense which may result in a engineering activities. claim. To the extent possible, such notice should include: CG D2 46 08 05 0 2005 The SL Paul Travelers Companies, Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY I. How, when and where the "occurrence" any provider of"other insurencc"which would or offense took place; cover the additional insured for a loss we II. The names and addresses of any injured cover under this endorsement. However, this parsons and witnesses; and condition does not affect whether the insur- ance provided to the additional insured by III. The nature and location of any injury or this endorsement is primary to "other insur- damage arising out of the"occurrence" or ance" available to the additional insured offense. which covers that person or organization as a b) If a claim is made or "suit" is brought against named insured as described in paragraph 3. the additional insured, the additional insured above. must: 5. The following definition is added to SECTION V. I. Immediately record the specifics of the — DEFINITIONS: claim or"suit"and the date received; and "Written contract requiring insurance" means II. Notify us as soon as practicable. that part of any written contract or agreement The additional insured must see to it that we under which you are required to include a receive written notice of the claim or "suit° as person or organization as an additional in- as as practicable. sured on this Coverage Part, provided that the "bodily injury" and "property damage" oc- c) The additional insured must immediately curs and the "personal injury" is caused by an send us copies of all legal papers received in offense committed: connection with the claim or"suit", cooperate a. After the signing and execution of the with us in the investigation or settlement of contract or agreement by you; the claim or defense against the "suit", and otherwise comply with all policy conditions. b. While that part of the contract or d) The additional insured must tender the de- agreement is in effect; and fense and indemnity of any claim or "suit" to c. Before the end of the policy period. I Page 2 of 2 ®2005 The St. Paul Travelers Curnpanies,-Inc. CG D2 40 08 05