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HomeMy WebLinkAboutInsurance Certificate: Brotherton 9BROTPI OP ID: MW CERTIFICATE OF LIABILITY INSURANCE D 06/05112 YY) 06/05/12 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 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 ( 541-079-5521 CONTACT . Hart Insurance - - _ . . - ".. 541.474-1690 PHONE FAX ' P.O.Box 1240 - A/C No Est: A/C No); Grants Pass,OR 97528 E-MAIL Hart Insurance Agency - ADDRESS: INSURERS AFFORDING COVERAGE NAIL 0 INSURERA:Travelers Indemnity Co 10647 INSURED Brotherton Corporation INSURERB:Travelers Property&Cas. Co. 10647 PO Box 738 INSURERC:SAIF Corp Gold Hill,OR 97525 INSURER O:FederalInsurance Co INSE INSURURER R F E COVERAGES CERTIFICATE NUMBER: REVISIONNUMBER: 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 EFF POLICY EXP LTR POLICY NUMBER MM/DDIYYYY MMIDDIYYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X C0526D9764 06110/12 06110113 PREMISES Ee occurrence $ 300,00 CLAIMS-MADE 1XI OCCUR MED EXP(Any one person) $ 10,00 PERSONAL B ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY X PRO- LOC -Emp Ben. $ 1,000,00 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,00 _ Ea accident B X' ANY AUTO 810526D9764 06/10/12 06/10/13 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident deductible $ 2,60ti X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,00 B EXCESS LIAB CLAIM&MADE CUP526D9764 06/10/12 06110/13 AGGREGATE $ 2,000,00 DIED i X I RETENTION$ 10,000 $ WORKERS COMPENSATION WC STATU- X AND EMPLOYERS'LIABILITY C ANY PROPRIETORIPARTNERIEXECUTIVE YIN 944526 10/01111 10/01/12 E.L.EACH ACCIDENT $ 1,000,00 OFFICERIMEMBER EXCLUDED? F—] NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 As,describe under CRIPTION OF OPERATIONS b=low E.L.DISEASE-POLICY LIMIT S 1,000.00 D Equipment 6685778 06110112 06/10/13 Deduct: 2,50 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Certificate Holder is named as Additional Insured. CITY RECORDER CERTIFICATE HOLDER - CANCELLATION SINGSHI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. Purchasing Representative 90 N. Mountain Avenue AUTHORIZED REPRESENTATIVE Ashland,OR 97520 Hart I su ante Age / f n / ©1988.2 10 ACORD CORPORATIO ghts reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD - 1 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY L' 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 oo- 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 and non-contributory 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 s Section III—Limits Of Insurance. for such loss, and we will not share with that "other insurance". But the insurance provided to b) 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- any 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 soon as practicable of an "occur- ii. Supervisory, inspection, architectural or "occur- rence" or an offense which may result in a claim. To the extent possible, such notice engineering activities. should include: CG D2 46 08 05 ®2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 MM COMMERCIAL GENERAL LIABILITY I. How, when and where the "occurrence" any provider of"other insurance"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 persons 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 specifies 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 at soon as practicable. the " on this Coverage Part, provided that the "bodily injury' and "property damage" oa 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. 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