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HomeMy WebLinkAboutInsurance Certificate: JB Steel OP ID: SL ACO�Q- DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 04/27/12 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 INSURERS), 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 503-224-2500 NAME:CONTACT Anchor Insurance&Surery Inc 503-224-9830 PHONE _ F 1201 SW 12th Ave.,Suite 500 ac Ne rt; NC No Portland,OR 97205-2030 E-MAIL - - John D.KIUmp ADDRESS:PRODUCER gATZE-1 CUSTOMER ID, INSURERS AFFORDING COVERAGE NAIC e INSURED J.B.Steel, Inc. INSURER A:Bituminous Casualty Corp. PO Box 4460 INSURER B Medford,OR 97501 1 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 MM/DDY/YYYY MMI JIMIL LTR DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X CLP 3569483 05/01/12 05/01113 PREMISES(Ea occurrence $ 100,00 CLAIMS-MADE'FX1 OCCUR MED EXP(Arty one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE' $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ 2,000,00 POLICY X PRO LOC $ AUTOMOBILE LIABILITY X COMBINED SINGLE LIMIT 5. 1,000,00 (Ea accident) A X ANY AUTO CAP 3569482 05/01112 05/01113 BODILY INJURY(Per Person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Par accident) $ X NON-OWNED AUTOS $ $ X UMBRELLA LIAB I X OCCUR EACH OCCURRENCE $ 5,000,00 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,00 A CUP 2592903 05/01/12 05/01113 DEDUCTIBLE $ X RETENTION $ 10,000 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If mom apace Is required) RE:BLUEBIRD PARK STAIRWAY REPLACEMENT-PROJECT NO.2011-32 CITY OF ASHLAND&ITS AGENTS,OFFICERS&EMPLOYEES ARE ADDITIONAL INSUREDS PER TERMS&CONDITIONS OF ATTACHED GENERAL LIABILITY ENDTS GL-4667-0111, GL-4665-0111 &AUTO ENDT A-2931-1199. 30 DAYS NOTICE OF CANCELLATION,EXCEPT 10 DAYS FOR NON-PAYMENT OF PREMIUM. CERTIFICATE HOLDER CANCELLATION ASHLA-1 D 0 SHOULD ANY THE ABOVE DESCRIBED POLICIES CANCELLED BEFORE THE EXPIRATION N DATE THEREOF, NOTICE WILL LL BE DELIVERED IN CITY OF ASHLAND ACCORDANCE WITH THE POLICY PROVISIONS. 20 EAST MAIN ST. ASHLAND,OR 9752 UTHORIZED REPRESENTATIVE MAY - 4 2012 l ©1966.2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo am registered marks of ACORD POLICY NO. : CLP 3569483 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS This endorsement modliies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Secllon II — Who Is An Insured Is amended to Include as an additional Insured any person or organization who Is required by written contract to be an additional Insured on your policy, but only will) respect to liability for 'bodily Injury% 'properly 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 projeot(s) designated in the written contract. 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 Insdred(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. This Insurance Is excess of all other Insurance available to the additional Insured,whether primary, excess, contingent or on any other basis, unless the written contract requires this insurance to be primary. In that event, this Insurance wilt be primary relative to Insurance policy($)which designate the additional Insured as a Named Insured In the Declarations and we will not require contribution from such Insurance if the written contract also requires that this Insurance be non-contributory. But with respect to all other Insurance under which the additional Insured qualities as an Insured or additional Insured,this Insurance will be excess. GL-4087(01/11) Includes Copyrighted Material of insurance Services Office With Its Permission POLICY NO. : CLP 3569483 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modules Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Section II — Who Is An Insured Is amended to Include as an additional Insured any person or organization who Is required by written contract to be an additlonal Insured on your policy for completed operations, but only with respect to liability for'bodily Injury' or'property damage' caused, In whole or In part, by 'your work' at the project designated In the contract, performed for that additional Insured and Included In the'produots-completed operations hazard'. This Insurance is excess of all other Insurance available to the additlonal insured, whether primary, excess, contingent or on any other basis, unless the written contract requires this insurance to be primary. In that event, this Insurance will be primary relative to Insurance policy(s) which designate the additional insured as a Named Insured In the Declarations and we will not require contribution from such Insurance If the written contract also requires that this Insurance be non-contributory. But with respect to all other Insurance under which the additional Insured qualifies as an Insured or additional Insured, this Insurance will be excess. GL-4665 (0 1/11) Includes Copyrighted Material of Insurance Services Office With Its Permission COMMERCIAL AUTO POLICY NO.: CAP 3569482 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED —SPECIFIC ENTITIES This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM: WHO IS AN INSURED is amended to include as an`Insured"the person or organization named in this endorsement. However, the additional insured is an"Insured"only for"bodily injury"or"property damage" arising out of work or operations performed by you or on your behalf for the additional insured and resulting from the ownership, maintenance or use of a"covered auto", by: 1. You, or 2. Any of your employees or agents; or 3. Anyone other than the additional insured or any employee or agent of the additional insured, while using with your permission a covered"auto"you own, hire or borrow. ADDITIONAL INSURED: Any person or organization for whom the named insured has agreed by written contract (insured contract) to designate as an additional insured, subject to all provisions and limitations of this policy. A-2931 (11/99)