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HomeMy WebLinkAboutInsurance Certificate: Cut N Break Construction Beecher Carlson 10/23/2012 2 : 09 : 49 PM PAGE 2/003 Fax Server �a`oRO� CERTIFICATE OF LIABILITY INSURANCE 10/23 2012' 10/23/2012 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 15 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 endorsemen! s . PROWLER NAME'O Susan Wilson, AAI, AIC Beecher Carlson Insurance Agency LLC PHONE (541)772-1111 AAIc Ne: (541)772-3785 707 Murphy Rd .swan.wilson @beechercarleon.cam INSURERS AFFORDING COVERAGE NAIL Medford OR 97504 INSURERAARIeriCan Rallmark Ins Co of TX 43494 INSURED INSURERS:SAIF 52412 Cut N Break Construction Inc IMURERC.WC5t4eZU-Surcty Company p 0 BOX 1455 INSURER D: NSURER Medford OR 97501-0108 I NRORSR E F: COVERAGES CERTIFICATE NUMBER:CL12 41214 4 70 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. ILTR A s POLICYEFF PDUCYEXP LINTS TYPE OF INSURANCE POLICY NUMBER MM/OWVYVV MIAIDDPYYY`/ GENERAL LIABILITY F 11 OCZURRENCE $ 1,DEC,000 TXCONiMFP.CWI GFNFRFI WRII ITT PREMISES E'a onvnancui $ 100 x000 A CLAIMS-NOD= FxIocCUR. X 14CL44930205 /13/2012 /13/2013 MED CXP IAnY one pe'eon) $ 5,000 PERSONA-&ALTV INJIRY $ 1,000,000 CENEMI K.CInEGME r 2,000,000 GENT AGGREGATE LIMIT A'PLIES P_F PRODUCTS-COMPIOP AGC $ 2,000,000 X1 POLICY PRO- M LnC $ AUTOMOSILELMSERY D.M 1,000,000 A x ANY AUTO BCD10 INJURI'i Put.enuq b ALL OIMIED SCHEDLLED 4CL44930205 /13/2012 /13/2013 ECDILY INJURY iPer amdenl) $ AUTOS NJTo, NON-OVAED $ H RED AUTOS AUTOS .Per nnHdanl Mem,al eme $ 5 000 UMBRELLA LIAR OCQJP EACH uCZURRENCE E EXCESSLIAB CLAIMS-MADE ACGREGAT_ $ C/EC FEE17I0N6 $ B WORKERS COMPENSATION YA 3TATIJR 0TH- AND EMPLOYERS'LIASI¢T' ANY PROWIETORF/JETPEP,1DECUTVE YIN E.L EACF ACCIDENT S 5C0,000 OMendiit M inNH)EXC IAECY,' NIA 89003 0/1/2012 0/1/2013 LL.DISEAtk-EA EMPLOYEE $ 500,000 It ws.o'nmbe timer DES CR IFTION OF DPERATIONSbelpw E.L.DISEASE-POLICY LMIT $ 500,000 C BOLI Bond (Statutory) 70106243 /5/2012 /5/2013 L,mn: $30,000 DESCRIPTION OF OPERAMNS I LOCATIONS I VEHICLES(AttaN ACORD 101,Addlicnal RemuMF Schedule,if mare space IF required) General Liability policy includes Blanket Additional Insured coverage as required by written contract per endorsement MP9538 (03/05) attached. CERTIFICATE HOLDER CANCELLATION (S41)488-5320 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland 90 N Mountain Avenue Ashland, OR 97520 AUiMIrOZED REPRESENTATIVE S Wilson, AAI, AIC/Su `� -.. /'J• �� ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201045)01 The ACORD name and logo are registered marks of ACORD Beecher Carlson 10/23/2012 2 : 09: 49 PM PAGE 1/003 Fax Server BEECHER . ,ARLSON Insurance Agency,LLC FAX TRANSMITTAL SUS5086A50EDF36 Date: 10/23/2012 2:09:14 PM Num of Pages: 3 (including cover) To: City of Ashland From: Susan Wilson Company: Direct Phone: (541) 494-2691 Phone: Direct Fax: (541) 772-3785 Fax: 541-488-5320 Email Address: susan.wilson @beechercarlson.com Hi, Kara at Cut N Break Construction requested that we send the following certificate of insurance to you for upcoming projects they will be doing for the City. Please contact me if you have any question or concern. Thank you. 707 Murphy Rd. Medford,OR 97504 (541)772-1111 Main (541)772-3785 Fax CA License#OF09618 OR License#816307 WA License#252204 \ -h:i31;-In 1e..1-asi,dn i- -onhdonh0l wid is intoriw �awh-to ttr usc, of itto .amod obr 11 yuu nrn 1101-.YUa irl halo;�qd a I R.ttftr5zod in doli,,a it I.C.flin t tutd3;t r-it.iunt yov ato hw by:advi =rai 1i. !r b:diar cr copnnq of thi_-onnlmu lbona lc prchitirao. If yo) 1 ccoi ad thin tnc Into irarsmi mn br m t }e, v0aso 1*06h,tto snndor mmodictcI -y talepiu c'and.,?turn ttn crldina a u:a;e Lansmrsioi to lt,a r.der t�,, u = fnaii Beecher Carlson 10/23/2012 2 : 09: 49 PM PAGE 3/003 , Fax Server POLICY.NUMBER: COMMERCIAL GEN ERAL.LIABILITY THIS ENDORSEMENT CHANGES:THE POLICY-. PLEASE READ IT CAREFULLY. BLANKET'ADOtTIONAL INSURED ENgOR$ERIENT This endorsement modifies the insurance provided under the following: COMMERCIAL GENERAL;LIABILITY COVERAGE FORM A. SECTION 11-WHO 15:AN INSURED is:arnended to include,as an insured any person ororganizatio, (referred to below as Additional.Insured)whum.yuu are ieyueeci,'.to add as an:additlonal.lnsured onahis policy under: t:. A written contract or.agreement.and 2. Wheie:a certificate of insurance showing that person.or organization as an additional insured has been issued;and 3. Men the written contract or.agreenient:and.the:cerdficate of insurance are currently n:effect or becoming in effect during the term of the policy and.executied.prior to the"bodily injury."-prupeity damage.I or"personal and advertising injury." B: 'The insurance provided to.the Addidonalinsured(s):is fmited as-follows: 1.. 'fhe Additional lnsuiud(a) is uufyaii edditiuiial insured for,: a. "Bodily injury, "property damage'or'personal and advertising injury'caused in whole or in pail by negligent acts or emissions of:the Narned: nsured or anyone directly or indirectly employed by the Nnmod Insured or forwho3e.ect3 a Named Insured may liable. b. Liability:arising out of vour ongoing operations to,,the-Additional Insured(s) by or for you, A person's or organization's status as an insured under this endorsement ends when your operatinn,s for that insared are L6inpleted.. 2. The Un tts of Insurance applicable to:the:Addtional Inswed(s) are those specified in the written contract or agrearnent butnot more than the Limits of lnsurance.specified in the Declarations of this policy. The Limits.of Insurance applicable to theAdditional-insured(s),are inclusive of and npt:in addition to the:Limits of insurance shown In the Oeclara*.ions forthe Named Insured. C. In addition to the other exclusions applicable to Coverages A, 0,and.C;the insurance provided to the Additioral Insureds),does:not apply"o- 1. "Property damage"to: a. Property owned, used; occupied by,leaned or rented to.the.Additional.lnsured(0 h. Property In the care,.custody or control of the Additional,Insured(s) or over which the Additional Insured(s) are for any purpose:exercising:physical control;or c. "Your work""performed for the,Additional Insured(s). 2, "Bodily injury, "property damage"or"personal and advertising injury°.arising out of an architec6: engineer's or surveyor's rendering or failure to render any professional services for you, for the 'Additional Insured(s)or for others including,but notlimftedao: a. The preparing; approving or failerc to prepare or approve maps; drawings,. opinions, reports, surveys,change orders,designs or specifications;or 6. Supervisory;inspection or engineering services. 3_ "Bodily injury"or"property damage"occurring after: a. All work,:ineluding:materials,.patis or equipment furnished in connection with such work,on the. project (other than service, maintenance orxapairs) to be performed by or on:behalf of the: :additional insured(s) at the.site.of the covered:operations has-heed completed;.or That portion of"your work"out of which the injury or darnage arises has been put to its intended. use by:any person or organization other thamanother contractor or subcontractor engaged.in :performing operationslor a-principal as a pad.of the same.pro(ect.. MP 95 38.03 05: Ineludeseopyrignted"material or lnsurarice Services Office,Inp.,with its permiseien.. Page 1 of 1