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HomeMy WebLinkAboutInsurance Certificate: JBR Environmental Consultants JBRC010 OP ID:JN CERTIFICATE OF LIABILITY INSURANCE DAT 07/30DYYYY) 07130/12 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(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 endorsemen s. PRODUCER 801-486-1373 CONTACT Olympus Insurance Agency 801-485-6943 PHONE FAx PO Box 65608 AIC No Exl: (AIC,No): Salt Lake City,UT 84165.0608 E-MAIL F.David Child,Jr. ADDRESS: INSURE NS)AFFORDING COVERAGE NAIC d INSURER A:American Economy Insurance Cc INSURED JBR Envrmmntl.Consultants Inc INSURER B:Homeland Insurance Co.of NY Attn: Robert Bayer 8160 South Highland Drive A-4 INSURER C: Sandy, UT 84093 INSURER D INSE NSURURER R FE: 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 ADOL UB POLICY NUMBER MMIDDY LTR IYYYY MMMDNYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2,000,00 B X COMMERCIAL GENERAL LIABILITY X X 793000210 0001 08104112 08104113 PREMISES Ea occurrence $ 50,00 CLAIMS-MADE 1XI OCCUR MED EXP(My one person) $ 5,00 B X Pollution Liab 793000210 0001 08104112 08104113 PERSONAL a ADV INJURY $ 2,000,00 B X Prof Liab Clms Ma 793000210 0001 08104112 08104113 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGO $ 2,000,00 POLICY X PRO. LOC $ JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,00 Ea accident A X ANY AUTO 02CE223524 08104112 08104113 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS AUUTOSWNED (Peer aPdem DAMAGE HIRED $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEO I I RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- ANDEMPLOVERS'LIABILITY YIN T ANY PROPRIETORIPARTNERIEXECUTNE F—] E.L.EACH ACCIDENT $ OFFICEWMEMBER EXCLUDED? NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ yes.describe under DCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Inland Marine 02CE223524 08104112 08104113 Rented Equipment 100,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) The City of Ashland, OR and its elected officials, officers and employees are listed as additional insured as per written contract. Insurance is primary S non-contributory as per written contract. Waiver of subrogation applies as per written contract. The agency agrees to give 30 days written notice in the event of cancellation. 10 days notice for non-pay cancellation CERTIFICATE HOLDER CANCELLATION CITYASH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CI of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City ACCORDANCE WITH THE POLICY PROVISIONS. 20 E.Main Street Ashland,OR 97520 AUTHORIZED REPRESENTATIVE F. David Child,Jr. y � ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD .�� JBRC010 OP ID:JN CERTIFICATE OF LIABILITY INSURANCE F DAT 07/30DII'YYY) 07/30112 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 endorsemen s. PRODUCER 601.486-1373 CONTACT 01 pus Insurance Agency 801485-6943 P"o"E FAX PG BOX 6$686 N E AIC No): Salt Lake City,UT 84165-0608 E44AIL F.David Child,Jr. ADDRESS: INSURER[S)AFFORDING COVERAGE NAIL R INSURER A:American Economy Insurance Cc INSURED JBR Envrmmmtl.Consultants Inc INSURER B:Homeland Insurance Co.of NY Attn: Robert Bayer 8160 South Highland Drive A-4 INSURER C: Sandy,LIT 84093 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 MMIDIDYIYYYY POLICY IYYYY LIMITS TR GENERAL LIABILITY EACHOCCURRENCE $ 2,000,88 B X COMMERCIALGENERAL LIABILITY X 7930002100801 86104112 88104113 PREMISES Ea occunenca $ 50,00 CLAIMS-MADE OCCUR MED UP(My one person) $ 5,08 B X Pollution Liab 7930002100001 08104112 88104113 PERSONAL B ADV INJURY $ 2,000,08 B X Prof Liab Clms Ma 793000210 0001 08104112 08104113 GENERALAGGREGATE $ 2,000,08 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMP/OP AGG $ 2,088,80 POLICY X PRO- LOC $J5CT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT E.O den 1,888,88 A X ANY AUTO 02CE223524 08104/12 08104113 BODILY INJURY(Per person) $ ALLOWNED F7 SCHEDULED BODILY INJURY(Per accident) $ AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTNE E.L.EACH ACCIDENT $ OFFICEWEMBER EXCLUDED? F-1 NIA (Mandatory In NH) E.L.DISEAGE EA EMPLOYEE $ I/yYes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Inland Marine 02CE223524 08104112 08104113 Rented Equipment 100,00 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Ansch'CORD 101,Additional Remarks Schedule,If more space Is required) The City of Ashland, Oregon, and its elected officials, officers and employees are listed as additional Insureds. The insured General Liability Policy is primary and non-contributory to The City of Ashland, Oregon, and its elected officials, officers and employees. The agency agrees to provide 30 days written notice in the event of cancellation. 10 days written notice CERTIFICATE HOLDER CANCELLATION ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CI of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main Street Ashland,OR 97520 AUTHORIZED REPRESENTATIVE e F.David Child,Jr. ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD NOTEPAD: HOLDER CODE ASHLAND JBRC010 PAGE INSURED-SNAME JBR Envrmmntl.Consultants Inc OP ID:JN DATE 07/30112 for non-payment cancellation.