HomeMy WebLinkAboutInsurance Certificate: T&M Excavation Beecher Carlson 1/15/2013 10:19:12 AM PAGE 2/006 Fax Server
013
CERTIFICATE OF LIABILITY INSURANCE 1 3.5 M/z 13
Lam' lfis
TNIS.CERTtTCATE 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 INSl1RANCE DOES NOT CONSTITUTE: A'CONTRACT -BETWEEN THE ISSUING-.INSURER(S),, AUTHORIZED,
REPRESENTATIVE OR PRODUCER, AND.THE: CERTIFICATE HOL DER
IMPORTANT:' H the'cerdficate holder is an.ADDITIONAL INSURED; -the pollcy(les)' must be endorsed. If SUBROGATION IS WAIVED, subject to.
thR [earlsand: Conditions' of the polity, ceftahlpollin s may require an elidoirser terit. A. statement on-tfils 'oartf Cato does riot conte%Aghts tathe.
. .
ceAiOcale holder !oaieu of such endorsornent(s):
MoWCER. CANT . Larry Thompson
Beecher Carlson Insurance Agency. LLC PHO1`°`• (541) 772-1111 (FA AY
No: that>r]t-3185
-707 Murphy Rd lar:fhc sdri@beedhercarlsoti-.corn
INSU'RERIS!:AFFORDING COVERAGE' mc'#
Miadford. OR 97504. MURERAAlferi-caa- Hallmark Ins-. Co o£ Tat 3494
INSURED IrauRERG_
Toby M' Munroe, DBA: T M :Excavation ihW64 R 6:
1796 Thomas Rd. INGURF.RO:
INSURER E :
Medford OR 97501 IrsuR:AtF:
COVERAGES CER7IFICATE:NUMBER:2012-13 AI' Cert's REVISION NUMBER:
THIS. IS TO-CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO T?ir INSURED NAMED ABOVE FOR THE: POLICY.PERiOD
NMAY BHETANDD OR REQUIREMENT, RTATICAFFORDED BY TOCYPOLICIE OR OTHER; DOCUMENT WITH SUBJECT TO 'fO TTO Vr TERMS),
CERTIFICATE MAY-BE ISSUE OR MAY PERTAW; TFIE INSURANCE O\' THE POLICIES DESCRIBED HEREIN 1S SU BJECT ACL':THE ' FERMSy
EXCLUSIONS AND CONDITIONS: OF SUCH POLICIES-..LINIMS SHOVMN MAY HAVE BEEN REDUCED: BY PAID CLAIMS:
um I LTR IYPE.OFINSURANCE POLICY NUNIMR Mmi F: PNIOOIYIYY URTS INSR :GENERAL LUBILttV cA(;!1.J000P.RENCF f 1,.000,Do.O
X .100,.000
X'. ,CJh1MEPCY`i GENC'TTW tY.B:SITY 'PR 5E5 e _ 4
A. :dAlms-MAOE.❑ ,000UP ECrd3799107 /l0/20I'L X30/201! MEOE (M, endp nl 4 5,009
Pmsur44&A:InljFr t J.,.')00.,00')
GENERAL:A,GREG<.SE.... 9. .2,:000.,000
GENL iiGGRE,xr M-R$.IT A-TUCS PER; PRLV cTS.-COMFJP aGC 6 2'000-;000
X. rlwcy `EST 1-1 LOC 1
'AUTOMOBILE LiA&LfiY I.UMB~N 11NGLELN1
^eiYU Conti .
BCOA'r:NJ.inY--rPer p¢rini. F
AN PII'rr,
ALL OWNED :wSCHEDLLED.
BCDLY NJURY;FV o21O3N1 $
Al Rr)5 ITO :
NON.o.aartn P ~'LS<T\ DAMAG . y
H REDALCPOS AUTOS xecddarv'1.
UMBREL.tA LIAB: OCCUR OCCLMOFNCE Y
E9GEBSIIAO- fLAPAJ:IAS A(-Y;REGATE T
bFG F-E`11 IOU''
WOWSRSCOMPENSATIUN 11C 5T<iU-. Utfa
. ANO'EMPLOY'RS' LWe1LRY YIN TP
A Y,'PFOFFIETOR PAR~pERR.~CUTYE E.L EA_F'Y-.CIE.cT f
OFFICEUAENEFRE-_LQEW- NIA .
iM.eMrtCry1RNH7 E.L.OISEA.rc-Ea €J.iPI D1'E $
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vPWIP'i0l; OF OFERTTJONS ndd. EL OISEea -.POLICY Y1IT f
DESCRIPTION OF OPERATDNSI LOCATIONS I VEHICLES(AHdd, ACORD 1o1,A4d1t1omi RO 2 9c14dul, If mq •ppcc~laigqulrwi)
General Liab..li Gy polidy ilri~ludes Primary S Non-.Contributory provicor- Per en3or ;.emetic .MP 97 67:10/10
(att_ached)where required by written 'contract:. This :farm. is subje t t6: policy terms con3Btions. &
rXClusions.
CERTIFICATE HOLDER CANCEI LATION
(541)488-5311
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE.
THE EXPIRATION OATS THEREOF, NOTCE'-WILL BE DELIVERED IN.
City of Ashland, Oregon:, its elected. ACCORDANCE:WITH THE POLICY;PROVIVION8.
officals, officers and employees
20 Fast Main Street AUn{DRIZEq P.EPRESENTATI.VE
Aahalnd,OR97520
r
Tarry Ttiompsor./LARR?" ~^t`"~a 1tig•.di»
ACORD'25(2010105): 6,,1968.2010ACORDCORPORATION, All rights: reserved..
IN§025 (2olweloi-. The ACORO name and logo.are registered marks oFACORD.
Beecher Carlson 1/15/2013 10:19:12 AM PAGE 3/006 Fax Server
:(5) Vandatsm and. malicious mischief: or
(6) Theft.
I;. The following is added to. A.2: Property Not Covered of the BUILDING AND PERSONAL PROPERTY
COVERAGE FORM.
r.: Property while stored or operated underground in connection with any ::lining operations.
d. The.0lowing is added 1O .Paragraph 2: of B::Exciusions uf(fie :CAUSES OF: LOSS -SPECIAL FORM:
n. We will not pay for loss:or damage: caused by puncture, bI woutand road damage totires and tubes mounted
on vehicles.: However, we:do payfor puncture, blowout or road-darnage'caused 5y a..spedfied peril.
o. We will.not pay for loss caused by humidity, dampness, dryness or changes in or extremes of temperature.
p: We will not pay fcr loss caused by the.weightof a load which, under the operating condilions:at the time of a:
loss exceeds the. registered lift:ng.capaary of any equlpment.ormsehine.
q:. We will not pay:forloss due to theft er:mysterious dlsoppearance.from any vehicle unattached container We
wlll pay for loss:dua to burglary when there are stgns of forcible entry to a locked vehicle or container.
e. E7. Valuation of the BUILDING AND PERSONAL PROPERTY COVERAGE FORM is deleted and.replaced.bythe
following:
7. Valuation
We will: detemtino the vaiue of covered property in the event of loss or.damage as follows:
.a. At actual cash value at the time of the loss (with a deduction for depreciation) except as provided in
graphsb. and c. follow ng;
Para
g.. Pair or Set, The value of a lost: or damaged article which is part of a pair or setis based on a reasonable:
proportion of the value of the entire pair or set. The Ioss:is nctconsidemd a total loss of the pair or set:
c. Loss. to:Parts. The.value of a lost or damaged part of. An item that.corisists of several parts when it is
compt2.le Is based on the value of only tale lost or damaged part or the, cost to repair or:repiace it.
2. Rental Reimbursement
.
In the event of Icss by;a coveied'peril to cowered wntraciprs: equipment that you own: we.-will relrrtburse ytxrfoc your
expense torrent similar equipment while your equipment is. inoperable. The. most we, will reimburse you for rental.
reimbursement-expenses is $1,000. We will continue to reimburse yoirforthe rental of equipme4anerthe expiration
date:of:this coverage provided the loss occurred.before.the expiration date.
We will not reimburse you:
a. If you can continue or resume your operations with similar equipment that. is available to you at no additional.
expense to you; or
b. For the rental expense of any equipment unless you make every: reasonable effort to repair, replace or rebuild the
inoperableequipment after the covered loss occurs.
3. With respect to this Additional Coverage, Contractors Equipment Coverage, Section D. Deductible ofth88UILD114G:
AND PERSONAL,PROPERTY COVERAGE FORM is deleted and. replaced by:the following:
D. Deductible
We will notoayfor'loss or damage in anyone.occurrance.until the amount of loss ordamageexceeds $500. We will
then pay the amountof loss. or: damage Inezcessof:$500 tip lothe:applicable limit of insurance.
We will not reimburse you forthe rental of.egtnpmenf until after 72. hours have passedsince the covered property
Was tendered Inoperable., After 72 hours have passed; we will only reimburse you for the rent at expense that you.
actually incur:
The deductible of $500 does notapply to rental reimbursement expenses.
General Liability Additional Coverages
Theifollewing Additional Coverages are added to the:COMMERCIAL.GENERAL. LIABILITY COVERAGE FORM.
A. Blanket Additional Insured Coverage
1. SECTION It-WHO IS AWNSURED of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM is amended to
includeas ari insured anyperson or crganizatiori:(refen'ed pas Additional Insured) venom yiau are requirerJtoadd asaa:
Additional Insured.on this policy under:
a. A written: contract or agreement,. and
b. Where a certificate of Insurance showing that persorr.ororganization as an additional insured has been Issued; and
Page :20. of 25 indu lcs cop}mghted material of Insurance services once, Inc. and MP 97 67.10 10
American Asseuacun of Insurance 5ervies,-Inc., with their permissfon
Beecher Carlson 1/15/2013 10:19:12 AM PAGE 4/006 Fax Server
c. When the written contract or agreement and certificate of insurance are currently in effect or becoming in effect
during the term:of the policy and executed prior to the 'bodily:injury," "property damage;'" or "personae and
advertising iniufy,"
2. The Insurance provided to the. Additional Insured is limited as follows:
a. The Additional Ensured is dnly.an additional insured for:
(1) "Bodily injury,""properly damage;"or "pa.,sonal and advertising injury' caused in wrote or hiparl by negligent:
acts or omissions of the;Narned Insured :or anyonediregtly qr indirectly employed bythe Piamedansured:or fqr
whose: acts a Named Insured, may be liable.:
(2)1 Liability arising out of your ongoing .operations'for the Additional Insured by or for you.. -A person's.or
organization's status- as an Insuretl.undef this coverage ends when your operations for that. insured are
completed;
U, i he Limits of Insurance applicaIble to the Additional Insured are those specjf eitin the written contract or agreement
but not more than the Limits of Insurance specified in the Declarations for this policy,., The Limits of Insurance:
applicable to the Additional Icisured are inclusive: of. and not in: addRion to the Limits of Insurance shown in the
Declaralaris for the. Named.lns'ured.
3 111 addition to.the other: exclusiens:applicable to Section I, Coverages A., B. and C. of the COMMERCIAL GENERAL
LIABILITY: COVERAGE FORM, the insurance provided to the Additional Insured does netapply.to:
a. 'Property damage" to:
(1) Property owned, used, occupied by, loaned or rented to:the Additional Insured;
(2) Property in the car(-,, custody or control oflheAdditlortalInsured dcrover, whlctithe, .Additional Insured arefor:ana
;purpose exercising physical control; or
(3) "Your. woi A' performed for ithe Additional Insured.
b. "Bodily injury," "property damage," or "personal. and advertising injury" arising out of an architect's, engineer's or
surveyors rendering or failure to renrleYany µrofessional services for you, for the Additional Insured or for others,
!ncluding, but notaimited to:
(1) The.preparing, approvlingorfailuretoprepare orapprove.maps,dmwings;;opinions,reports, isuNeys,change'
orders; designs or specifications; or
(2) S >penrsory,:inspection or engin+'_eri tg services..
c. "Bodily lnjury or"propertydamage'occurring,after
(1) :AII work, including materials; parts or equipment furnished in connection with uch work, on the project (other
than service,. maintenance orrepalrs) lobe performed. by or on behalf ofihe additional insured at the site of the:
:covered operations has been completed; or
(2). That portion of "your work' out. of which the Injury or damage arises has been p-it:to Its intended use by any
.person or organization other than anther contractor or subcontractor engaged in performing operations fora
.principal as a part of the same project.
4.: SECTION IV - COMMERCIAL. GENERAL LIABILITY CONDITIONS, Paragraph 4. Other Insurance, is amended to
add the following subparagraph:
d. Additional Insured's Other insurance As Excess Insurance
To the extent required by an "ihsured'contract," this insurance is pnmaryon behalfofthe Additional Insured; and any
other Insurance maintained by the Additional Insured is excess and riot contributory with this insurance. If the'
"Insured contract" does not require this: provision, then Paragraph A. above will apply.
B, Moblte EqulpmentBroadened Coverage
V.12.f.(1) of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM is replaced by the following:
(1) Equipment deslgned.primarilyfor,
(a) Snow Removal;
(b)! Road' maintenance, but not construction or resurfacrrig,, or
(c) Street cleaning.
Except the above provisions do not applyto self-propelled vehlr_les of less than 1,000 pounds gross vphicle.weight which
are not Intended for use an a highway.
c. Aggregate Limit Par Project.
The General Aggregate Limit under SECTION III - LIMITS OF INSURANCE of the COMMERCIAL GENERAL LIABILITY
COVERAGE FORM applies separately to each of your projects away from premises owned by or rented to you,
MP 9767 '10 10 Includes copyrighted material of Insurance services oftie., Inc. and Page 21 of 25:
American Assouatton of Insurance Services, Inc,,. corm their permission
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.D. Blanket Waiver Of Transfer OfRights Of. Recovery Against Others To Us
The Transfer Of Rights Of Recovery. Against Others To Us Condition (SECTION IV -.COMMERCIAL GENERAL
LIABILITY CONDITIONS) is amended by the addition of the following;
We waive any right of recovery we ril have against any person.ororganization to whom you bywritten contract orwritten
agreement have waived yourown rgtit or recoveryfor loss caused bythat person or organ, because otpaymentswa
make for Injury or damage arising o!utof,,your ongoing operations or "your work" done under a written contract or written
agreement with that person or organization and included in the "products.competed operations hazard."
This provision does not apply unless the:writtencontract or written agreement has been executed prior to the "occurrence' or
offense giving rise to the ".bodily injury' or "property damage."
E. Voluntary Property. Damage Coverage
1; We.will, at your request, pay but not defend, anyclalIn for "property, damage" to the property of others otherwise excluded
under A.2.j.(4), (S)and (6) of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM provided that:
a_ Such "propedydamage" takes plane while such propertyls in.your care, custody, oorcontrol, oris properlyof others:
over which you, forahy purpose, are exercising or have exercised physical control; and
b. Such "properly. darriage" takes place away from any premises:you own, rent or lease: and
c. Such "property darrag0takes place withinthe'coverage territory" and during the policy term; and
d. Such "properly:damage" takes:place-only during youroperattons that are known to us, are scheduled on the policy
and for which a premium has f een.charged.
2 The insurance under this additional:coverage does.noi applytp "property:damage" to property.
a. 'Held byyou for servicing, repairslorage or sale at premises owned by, rented ,or leased: to you;
b. While being transported byorcaused by the ownership,. maintenance; operation, use, "loading:orunloading"of any
"auto," watercraft:or!airciaft, or
c. Owned or occupied by or rented to you..
3. Deductible.
This additional coverage will apply only:tothat amountofany less in each "occurrence" that exceeds $500:
The terms of the policy with respect to.yourduties in the event of "occurrence," claim or"suVandthe Corpany's right to
investigate; negotiate and settle anyclaim or'siiit" applyirrespective ofthe application ofthe deductible amount of$500.
We.may pay any pa l:or all of the deductible amount of $500 to effect settlement of any claim or "suit" Upon notification
ofthe action taken, you must promptly reimburse us for Such part of the deductible amount as has, beehmpaid byus,
4. Limits of:Lfabilify
The Limit:of Liability forthis additional: coverage shall not exceed S2,600 for each'bccurrence":and is Ihe, limit of the
Company's liability for all damages onaccount of each claim or "suit' covered herein. 'The annual aggregate Limit of
Liability is $2,500 and is, Subject to the above provisions respecting each claim, the total limit of the Company's liability
for all damages.
5. Settlement
In the:eventof loss covered by this additional coverage,.you shall, if requested byes, replace.the property orfurnish the
labor and materials ne cessaryfor repairs thereto at actual:cost to you,.excluding prospeaive profit or overhead charges
of anynaoure. Any property so paid for or repiaced shall, at our option, become theproperty of the Company. Payment
hereundershall notconstitute:an admission of liability of you or, except as:stated herein, of the Company.
Additional Conditions
:A.: Insurance Under.Two IOr~More Coverages
Thefollowing is added to Paragraph: C. Insurance under Two or More Coverages of the. COMMERCIAL. PROPERTY
CONDITIONS:
if.a:Coverage form. is attached to this policy that:provides a:lirnitlor any coverage provided by thisendotsemeot the limit.
shown in the SCHEDULE andl the coverage provided by this endorsement are deleted and replaced by the limit and
coverage provided by theOoverage Form:
B. Limits Of Insurance
Regardless ofthe number of buildings ata location covered by this endorsement, the most we will pay under thiG:Coverage
Enhancement endorsement inanyone occurrence is theapplicable Limits of Insuranceshown inthe SCHEDULE on page 1
of this endorsement.
Page 22 of 25 Inoudes roryd g.Madmateriat of Insurance Services Office, Inc. anI d MP 97 57 10 10
AmxriCan:Assnuatfon of Insurance Sowicas, inc.,. with 1Freif permisslnia
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C. Deductibles
The Deductible described in section D. of the BUILDING AND PERSONAL PROPERTY COVERAGE FORM apoliea to
each -oftheCoverage Enhancements except as shown below:
We will not pay for loss ordamage to anyoneroccurrenca until the amount of loss or damage exceeds:S500. We.will4hen
pay the amount of lossor damage in excess of $500 up to the applicable Limit of Insurance for the folowing enhancements,
1. Personal. Effects and . Property of Others
Z,. Valuable Papers and Records (Other then Electronic: Data)
3.. Properly C)ff-Premises (Including Laptops and Other Electronic Equipment)
4. Outdoor Property (Named Perils)
5. Accounts: Receivable.
6. Property in Transit(Including Laptops. and Other.Efectronic Equipment)
7. Fine Arts
8. Electronic Data.
-9, Water Back-Up.. and:Sump:Overf!ow
10, Employee Theft
11, Money ahd Securities
12.. Forgeryor:Alteration
No. deductible provisions apply to the following enhancements:
1, Fire Department Service Charge
2. Arson Reward
3. Claims Expenses.
4. l nventory or Appraisal Cost
5. Recharging of Fire Extinguishers
6. Rentaf Reimbursement
tT Additional Definitions:
the following Additional Definitions appiy to this endorsement, only;
1. "Bunking Premises" meeirs the interior ofthat portion of:ariy building occupied by'a banking institution or Simllarsafe
depository.,
Z, "Business Income" means the:
a. Net.lnevme (Net :Profit : or t-os$ before Income taxes) that would, have been earned-had no loss occurred;,and
.
b. C;oruinuingnnrmal operating -expensesincurretl, i ncluding payroll.
For manufacturing risks, Net income includes the net sales:value.of production.
3. "Client' as used in Employee Theft Coveraga.means.any, entity for whom you..perform services under a written
agreement.
4; '+Client" as used in Contractors.EqulpmenfCoveragomeansanindividual,componyororgani icnwithwhomyou
have a written contractor work orderfgr your:servlres fora:describadpremisesand have billed for your services:
5. "Employee" as used in :Employ" Theft and Money? rid Securities Coverages means:,
a. "Employee" means;
(1) Any hatural person:
.(a) While:in.yourswvice.or1w30days.aftertermination of Service:
(b) Who you compensate directly bysalary,.weges or commissions; and
(c) Who you.have the righfto direct and, control.whlle performing services for you,
(2). Any natural person>who Is fumished temporal ly: to you::
(a) 'To substitute fora permanent "employea" as defined in Paragraph (1) above; whets on leave; or
To substitute . .
(b) To meet seasonal or short-term work load conditions;
while that person Is subject to:your direction and control and perfonning'services.for you, excluding;.
however, tiny such person while having care and custody of properly outside the "prertilses
MP 97:67 '10 10 Induces copy igntudmatetlal of Insurance services Once, Inc. 2nd Page 23 of 25:
American. Association. of Insurance Services, Inc.,. with their permission
Beecher Carlson 1/15/2013 10:19:12 AM PAGE 1/006 Fax Server
np
J._~=CARLSON
BEECHER
Insurance Agency, LLC
FAX TRANSMITTAL
LAR5OF52DO9401C
Date: 1/15/2013 10:18:36 AM Num of Pages: 6
(including
cover)
To: City of Ashalnd From: Larry Thompson
Company: Direct Phone: (541)494-2657
Phone: Direct Fax: (541)772-3785
Fax: 5414885311 Email Address: larry.tompson@beechercarlson.com
707 Murphy Rd. Medford, OR 97504 (541)772-1111 Main (541)772-3785 Fax
CA License #OF09618 OR License #816307 WA License #252204
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