HomeMy WebLinkAboutInsurance Certificate: Curtius Huntley Plumbing Beecher Carlson 3/28/2013 1:33:11 PM PAGE 2/006 Fax Server
CITY RECORDER
SD PA"CE IMMIDL'IY\V V).
! CERTIFICATE OF LIABILITY INSURANCE 3,?3,2D13
THIS CERTIFICATE IS ISSUED.-AS A MATTER UP INFORMATION ONLY AND :CONFERS NO RIGHTS UPON THE CERTIFICATE 'HOLDER. THIS.
CERTIFICATE: DOES NOT AFFIRMATIVELY OR: NEGATIVELY AMEEND, EXTEND OF 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(teS) must be*endOrsed: If SUBROGATION IS WAIVED, subject to.
the terms and:condnlons-oflfie policy, certain poli(Hes may}equire an endorsement. A statement on this cartlficate- does. not confer rights to;the.
certificate holder Imllvu of such endorsements
cANETAcT LarrY Tho>°Pson
PRODUCER, NAM:
Beecher Carlson Insurance Agency LLC PHCrI£ E (541) •772-IXII Falc Hot: (541k172-370$
-707 Murphy Rd ka1h Parry: tTLOmpsori@beeclieroazlsen:coa:
INSURE 5'A£FORDING G OVERAGE: NAICT.
Medford. OR 97$04, INSURERAA1t1Eri.Caa Hailmark Ins. Co of TX' 3494
IWUPEC IN50RERs ATAeri:can States Insurance CO 1 9704
CL'rtius Huntley Plumblug Inc INSURERC:SAIB' CO oratlou : 2412
1896 neita. waters Rd INSL'R£R D:
INSURER E
Medford. OR 97504 INSeR=_R
COVERAGES CERTIFICATE. NUM.RER:2012-13. GL, Auto, WC AribB: REVISION; NUMBER:
TH . .
IS: S -76,c ERTIFY THAT THE'FIOLIC15S OF 1NSURANCE LIS-fED BELOW HAVE. BEEN, ISSUED TO THE INSURED NAMED. ABOVE FOR THE POLICY PFR;06
INDICATED. NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT Wjfl; RESPEGT TO WHICH THIS
CERTIFICATE MAY 9E ISSUED OR MAY PERTAIN THE:INSURANCE AFFORDED BY THE POLICIES DE5CRIBED-HEREIN I$: SURACT f0 ALL THE. TERMS;
EXCLUSIONS AND CONDITIONS:OF SUCH POLICIES: Likurs SHOWN MAYHAVE BEEN REDUCED. BY PAID.CL'AII/S:
=R] - POLIG EPP POu CYE P
ADM I IR TYPEOFINSURANCE ¢ POLICY NUMBER M IDDIYYV MIAmILVYYY WATS
GENERAL LIMUN EACH OCCURRENCE $ 1,900,10
x: Cpha1FPCU: (-F.NFHA.M1IA!' l[5' REMr SEi oli~i+ancri $ .100,.000
A -ai¢lA3+wu^'_, ,pCalP: 4CL474614. /15/2012 /15/2013 IAEO CKP.jM{ en'o F"cn) $ 5:,.000
pFmspuAL&Apliw4J v $ i., 00.0., 000
. pEiiFnY T9CIl[LAiE 4 '2, UOD,:OOn
3ENI.G REaATE. LJM17 A*U12S P--F, PRQCI'CTf ~CO!dFNP 4Gr. $ 2/000,000
x. FOUC vRU LOC. $
AUTOMOBILE LiAWI-FY _ .,k _IN;LC L,M1.
B X ANYAL170' U!;U21 WJULYP'F Finavrl $
ALLC0NF0 SCHEDLLf.D: iC35575230 /15/2012 /15/2013 aCD41 INJURY Pe.'Cdd'nl) $
. AO.T05 :MJTO=
NMZO'.M40) Aa Y
.HPEL1AUT0S :AUTOS -x~Ir!an'
$
X UMBRELLA LIPS' O4CUY E H'>C L QPNCE $ 2 ,:000, 000
A EAeESSL1Ae' lcl N AJE' nc-srE-Ar? $ 2, OOO,boo
$
UGC x FE NTIVN R 4CDA74615 /15/2012 5115i2013
C WORKERS COMPEPISARON ~s M.C STATU Oak-
ANDEWPLOY-RS'LIABILITP i IVIT-
YIN 'e.I. E/. FACCIDENT $ S00 000
AN/ GFt P E Fk XC •fiRIFJCCJI'v' El NIP
(M.Id. IA.. NHI Fh.IDEC': E9113. 'P /,1/2012 in/l/20 13 kL_11 bltc to eMPUi1t_ T 500 000
LMandaNN eC t b ndd
C TIONa uner
$ -700 -0DO
DEsiCRi PnONJF ;GERArk; EL CIWI^aE -PVICY LIMIT
NStGe'rc-
DF.SCMPTON OFOPERATIONSI LOCATON3 I VEHICLES (.A(tau ACORA 10A dU IRembk 9 badule,IFm Pe If rdyOred)
Geaetal _1:iaki3.1lty policy iriludes Addiciona] Yn_i4ured coverahP on a primary G' nononntrilutory pas}s per.
eridosdement. 1.7P•9767101D (attached). Taw's form is 'subj:ect to policy terms, conditions, and exclusior(s...
CERTIFICATE-H O Lt)ER CANCEaxnbN
(641) 490-5320 SHOULD.ANY OE THE ABOVEDESCRIBED POLIOES.BE CANCELLEDBEFORE.
THE EXPIRATION GATE THEREOF, NOTICE' WILL BE DELIVERED IN.
pCCORDARCEWITH THE POLiCQ.PROVisiphs:
City of S+5hland
20 Fast. Main Street' - nvrm"rR7zeo RtrREZENrATwE
,Ashland, OR 97520
l.arrf'T1i'rymp5nr/L:ARRY r~J 7A;ay ~,}.,r
ACORD 25(2010/05): 'A? 1988-3010 ACORD CORPORATION. All rig tits, reserved.
1N5025(?ciJns 01. The A[O. RD name and logoare registered marks of ACORD.
Beecher Carlson 3/28/2013 1:33:11 PM PAGE 3/006 Fax Server
POLICY NUMBER, " COMMERCIAL GENERAL LIABILITY
GC 10:-25 07 09 -
THIS ENDORSEMENT CHANOES THE Paucy; PLEASE READ IT cAREFuLLY;
OREGON BLANKET ADDITIONAL INSURED:-
COMPLETED OPERATIONS
This endorsement modifies insLlrarlce provided underthe foliowiitf:::
COMMERCIAL GENE RAL.L ABILITY COVERAGE ART
A. 3ertion 11.-'W Is: An Insured is ?mended tg:incltula as an additional nsiired any p. r9arlor organization
for whom you are perfonn1W operations waen::you and sgch person:orol'ganlzation have agreed in wfiling In:
a contract or :agreement that such. person or organization be added a$ an additional insured for c7napleted
operations. Such person or organization is an additional insured only to the extent that the ilabllity for %rdily
injury, di "p.gperlg:oainage":is eauser3,. hr: wfttrle or in.pau, by. "yciii work" perfoianed forrlhal additiunzil inn
,tirtrt and included inf the "6rddijctw..rm.Ale(0:.c.,1)6rAt(6ns hazard
B. With respect to the insurance afforded to these additional Insureds, the following 11mitationseapoly:
1,., Thls aCtilUOnabmsyced s,aiias is :granted, only :at the locattons-IIste6In r,ewritten contract.
2. coverage 1s Ilmltod to "your xork"that Is described in the c assifications or schedule of hazards shown 1n.
the General Liability Declaration, of this policy,
C; With respect.tp the insurance afforded to thew aodtttdi al insureds; the follgWiri0 e$clusibh:appliesi
This:r nsuran ce;cloes not. aiiiily fd:
"Bodiiv injury" or'property damapd' which. occurs :prior fo the execution of the:written contrect:.or the effec,
tive dale of this:endomement. .
GC 10 260700 1 noludoz :oo;yrigtt_d.:maferiol of Page. l::of 1 C1
Insurance: Services Office, int:,w th its permi2sion
Beecher Carlson 3/28/2013 1:33:11 PM PAGE 4/006 Fax Server
z. EJ-VaNotion of the BU1LDfNG AND PERSONAL PROPERTY COVERAGE FORM is daloted and:r?placed W0.0
following:
7. 'Valuation
N1re:wiII deterirline:she.va ue::ofcoveredzpronertp-in the event of loss er damaga~as'fuliows,
a;. At actual cash va'ua at the time of the foss:(with a deduction far depreciation) wwept.as provided in
Paragraphs b. and c. following:
b. Pair or Sof; ThP valua:ot a,Iost ordamarled attible Which. is part of a:pair or set: is based oma; reasonable:
proportion ofthe value.of:the enure pair or set, The loss is.not considered a total loss of the pair or set,
c. Loss to Parts, The valueof a lost or damaged part of an item that eonsrsts of several parts .when _it.is
coinplate is based on the value of urily the lust or, damaged part of the cost to repair or replace it:
2.. Rental Reimbursement.
in the evani of loss by a. coveted pe,r`il to coveted contractors' equipmentthatpott own we Willl. re mbursa you for your'
expense to fent'.similar equipment while your equipment.* inoperablo. The most .we will reimburse you for rental
einrbutset rentezpaaS s is $1;000, We will continue to reimburse you:for the rental:ot:eouipmert.after the expirafon:
daW, 01 this coverage provided the loss occurred, before the expiration' date.
Wa will not rain i sa'you.
a. If you can:continue or resume.your operations with: similar equipmentthat.fs available to you at no add+.ioriakexpense.
to you; or
b. Fortbb rental oxp¢nsc:-of ant!:aquip[rsnt:urlloss you-innke every:ieasgnabie:c-i`foit to repait,;ryplacgticrequiid tFie:
inoperable equipment after the covered loss occurs.
3.. Willi iesriect to this Additiona! Coveiage,:Contractats Eggipment.Cov$rage Section D. Deductible of ttla BUILDING:
AND PERSONAL PROPERTY COVERAGE FORM is dolated and replaced by tho,follow.ng(i
D. per u.udble
WE) will n ot'pay:forloss: or da mage in any one: o courrance' until the amount of Ioss:or damapa: exceed s:S500, kNe.vuil
than pay the amount of:Ioss or damage'in excess of.S500 uplo:tha applicable limit.of:Insure nce.
We will no(reimburse:you for:th6 rental of equipment until after 72 Inours have.passed since the owered.prbpertyt4aa
rendered inoperable. After 72 nouns have passed, we wit1 only reimburse you for the rentat expense tt.atyou actually
Incur.
The deductible of;$500:6oes'not apply to Centaf reirnhtrrsement sxpenses.
Go nsraI Lia bi lity Additiona I Coverages
Thefoilowina Additional Coverages are added to the COMMERCIAL GENERAL LIABILITY COVERAGE FORM:.
A. 6la nket-Add Rionl tns ire d;COve.rage
SECTION if.-- WHO IS AN INSURED: of the GoMMERCIAL.GENERAL LIABILITY COVERAGE FORM is:amend ad to
IRcluda as an-insured any_person or.orgap2a nOn_:(referfed tU:as:Adcitional Insured) Whom you are reguireSto add as an.
Add uo.nal Insured on this policy under
a. A Written Pontractoragreement, aril
b, V4(he[a8.per9flCate;OfjrlSUFances owing.thatpersonororganl;* trop:a5anadditionalinsured .haslieerrissued;and:
When the writlen contract or agreement and certificate of insumnce:are currently to effect or becoming in effect
"petsonal.andsdvertising:
duringltie.ter.n ofatie pbticy and executed pi or to the "bodily utJuiy," "property iia6:mege." of
injury;
2. T no insurance providLdAQthe AddjUonal Insured is limited as.;foilows:
a.. The Additloiial. Insured is only anadditional brined for:
{1) "BorJily intury," 'proporty darriafte.," or"personal and adver,tsing iiijury" caused it whole or in part byinegliflent
acts:or orn!ssions':of the Named Insured:.oranyone:diroctly cr indirectly employed, bythe.Named.lriaured.or for
whose acts :a Narnied Insured: may be liabls.
(2) :L{ability. arising. out (if. your ongoing operations for the, Addftional Insured. by or for you.. A person's of
or'ganlzatfen:'s: status' as. an .Insured.;under ' this coverage ends when. your operations- nor that insured are:
cnmplefed.
Ii. TheUrNts:ofInsuranceapplicableto.theAddidonatlnsuretlarethose oecifiedin'thewrittencontrkforai:reemerit
bul.not:more: hiin.4he. Limits of,In rance.spe6fie4 o afte Dbdata6ns for ftus policy,. The Limits of,lnsut`ancc:
Page 20 of Z3; inelucw copYfghfM fnairrja.s otlrtsumnc Re ke$ Ofioe,.I6c:.arid PAP yl 6710 1.0
- .Amrban Aswdatio.^,a:Insurance;5ernces; !r>r:,~Qt~.tSelr permission
Beecher Carlson 3/28/2013 1:33:11 PM PAGE 5/006 Fax Server
applicable in the Additional Insured ale inclusive gi.arjo.nrt in; addition to the:LimN of:ir surance shown. in the
Declaiat,&z for the Named Insured'.
3. In addition to the other axclut,icns applicable to Section t, Coverages A., B, and C. of the COMMERCIAL GENERAL
LIABILITY COVERAGE FORM, the:insueance pruvidbd.tc the, Additional::G,smod doos. nctLapply to:
a., "Propertydamage"lo
(1) Property owned:, used, occupied by loaned or rented to the Additional Insured;
(2) Pro.pertyinthncare, custody:orconfrolafthe;Adiationaiinsured: or:over Which 'the Additional mwred;are.furanypurpose exercising phyt,,cai contfol; or
(3) Your work performed for the A.dditionaltnswed,
h; "POddy i rjrlry "'property darnego " or persprial and ndyertisirig injtini srisino. out of.+n arch teas engineer's or
stir eyor's ren,dering or failure to render any professional servtc.es or you, for the:Additional (nsufed or for others,
incruding, but not lim)ted to,
(1) The preparing, approving orfailure to prepare or approve maos, drawings, opinions; repots, su veys, change:
nttiEwe., designs: orspecificalipns; ar
(2) Supervisory, inspection orenginepong semoeS:
'propeity damagA" n ni uhg afler
°BndAy injti ry" or
0 ) All Work,, including materials, parts or ayuicment furnished in corineclion wjlhsuch work, on the :project (other
than service,. maintenance or repairs): tobe. performed by or. onbehalf of the additionat.insured atfne:site.of the:
duvrred operations has to en'complotpd;br
(2) That portlo^ of your Nurk dot ofwhrch the injury or damdge.arises has: been put to ifs.intended: use by any.
person or organization other than another cantractor.or:subcontractor engaged in performing operations fora:
principal as a pair of the same: project.
4. SECTION IV-COMMERCIALGENERALLIABILITY CONDITIONS, Paregraph4.Othezirisurance,batnehded:toadd
the following subparagraph:
d. Additiorfa(Insured'sOtherlnsuranaeAsExcosslnsuiranoe
T6 the extent regt fired by an `insured contract ,"'this insuranceis pfimaryon behalf .'ofthe Additional Insured; and any
other insurarice maintained by the.Adciticnal Insured is 'excess and not contributorywith this insurance. ftheinsured.
Contract does not requireahis provision, than Paragraph a. above will, apply.
8. Mobile: Equipment Broaderte&COVerage
V,12,f:{1,) of the:GOMMERClAL;GENERAL LAFlLITV'COVERAGE FORM is rcplaccdby the following;
(1) Eouipmentoesigned primarily for'
(a) Show,Ren oval,
(b): Road rnalnterlance, put not:cohs.lrucJan or resurfacing;:or
(c). -Street cleaning.
Except the above provisiorz do not apply, to self-propelled.vehicles of less than 1000 pounds gross vehicle.-#eight which.
are not ntdndad'.for, use on :a highway.
C. Aggregate LinnitPer. Project
The General Aggregate 1 unit: under SECTION lif> LIMITS OF INSURANCE of the COMMERCIAL GENERAL LIABILITY
COVERAGE FORM appiiosseparataly'to each of.your ptolects away frompromises: owned by or rented to -you.
D. Blanket:Waiver.Of TransferO.f Rights Of RecoveryAgarnst Others To Us
The Transfer Ol Rights Of Recovery ' Against Others To Us Condition (SECTION fV - COMMERCIAL GENERAL
LIAQIL)TY CONDITIONS) is amended by:the, addi;ion;of the following.
We, waive any, right:of recovery via may have apgainst any person;or organization to wileln you by written cpntraot or written
agreerne A havu.waived your own fight or;eaovwy fOr Ias' caused by that person of of ganizatiun because of paymcals:we
.
make: for injury, or o.am>ge ai:erng put of your orgorig operations or "your worY," don@ and or a written rnnuact ar Written
agreement with that pe son or organ zallon and included in the "products-completed operations hrazard "
This: provision does not apply :unies treWritten: contractorwrixsnagre6nont:has boon exscutdd,"pdartothe`6ccurrence'or.
offense giving rise to the "bodly:injury or "property darnaga."
E. Voluntary Property Damage Coverage:
1. vVawdl atyaurrequest;paytwtnntdefendanyclaimfor"propertydainbge tottieprap.,dyofathersnfherrnseeudlurled.
uitovr'A.2.j:(!3), (5) and:.(6) of the.COrVlk&ERCIAL.GENERAL.UABILII'Y tOVERA.GE FORM .P 6vided that:
of 91-67 10 10 !n!Ud(;`6 c[,oyrl9hrcAS rlal€rl84of1nsNranee. SeryAce' r)fige,.inc:arty Page,21 of2bi
. 4meican Association of Irc..~v .htheir y~.nrlsSinn
Beecher Carlson 3/28/2013 1:33:11 PM PAGE 6/006 Fax Server
a: Such property darnage akes place while.such pfoperty.is in your :.care, custodyo.r control: is property of thers:
over which' you, for any purpose, are exercising orhave;exarcised physical controi; and
b. Such "property damaga:`takes place away from any premises yei', own, rent or lease' and.
Such. ''prooenycemagW takes-place within the. "coveiape taflitory".and during: the policy term., and
d. Such "property: damage" takes place only during your operations! that are known to us, are scheduled .on.'he poliey
and for'wnich a.pfemium has;been charged,
Z The insuranceunderthis additional coverage does not apply to 'propetiydamage";.0 property-..
. a. Held.by yott for servicipg, repair. storage or :sate at pretrtises owned by, renter( or leased to. you;
b: while. being transpoae&by orcaused by the oevnersNp..main,enance_. operation, use, `loadifig or.unloadinw' ofany
"auto,'w'atercraft or airrraft::or
c. 0-weed or ur .up!ed by or rented to. yon.
3. Deductible
Tnis:eddiu utal cuvclage. wifll:appiy oply to that atrtuugL:of';ony Io s rr each-"nccw'renca Ira( exueecb.$500.
Tnete.msuft<`ie'~olicywitn"respect.toytiuriiirties,in.ttiezveiitof ocrurieric= claim or smt'a~~dtheCompanys fgYCtu:
investigate., negotiate and:settle any claim or "suit" apply irrespective, of the"application of the deductible arnountof $$00..
We may, pay any part oratlotthededurtlbleamounLof$50ato.effectsettlen,entof art? clai;ioh"soft Upan:noUfidaBOn
ofthwaction;taken you nt stpramptlyie abuse sforsucMpart of thedaduotblsamount~as.tiasbeenpaidoy0
A. Lirii0s of Uiti ilffy
The Limit: of Uabilityfor.this addiUonai co'erage:s#tall not exceed $2;500 for each'!accurreneo" end is ilia limit of the
Gornpany's liability for all dornages on,accourit of each;claint or suV covered'hetein. The annual aggregate U+ it of,
Uability',s $2;500 and Is; suLbjectto the aboveprouisions respecting each claim; theiotal Ifmit of the Company's liability for
all,darnogos.
5. Settlaimem
Inttie:event: of loss rove red by:this additional.coverage, you. shall, iflreauested:by us, replace the, or furnish the
tabor and.rnateriMsa necessary for repairs thereto at actual costto you, excluding prospective profit or overhead charges of
a ry .nattire, Any properly so paid for or replacedslfall, at eur:nptior.,;become the property of the Company: Payment
hereander:shall notconstitute an admission of:liabilitymf.you.or; except as stated herein, of:J e Company.
Additional Conditions
A.. Insurance Under Two Qr Agr,e Coverages
The foll'awing is added to Paragraph C.=Insurance under Two or. More Coverages cittheCOMMERCIAL. PROPERTY
CONDITIONS:
If:a Coverage Form is altached to th!spolicy, that provides xlimit for,ary coverage provided bythis :endorsement: thelimit.
shown in the SCHEDULEandthe coverage,providedbythisendorsementaredeleted and replaced by:theiimitandcoverage
prpwAded by the Coverage For
B. Limits OTInsurance
-
Regardless of the number of builclings ata location covered bylthis :endorsement the mostwe vtiil'pa{under-this -Coverage
Ehhanceinent endorsementin>arty onc. ocesitrence is the. applicatile.Limits of insurance-shown. in the SCHEDULE on page 1
of his endorsement.
C. Deductibles
The,Gaduchble c ascribe 1 in sec oq D, oftlie BU1L()ING AND f?ERSONALPIROPE RTY COVER,AOIE rOR!Vl applies tv as 1i
Of rile Coverage Enharcamerats excepf a<showa peliny.: '
Wewill. not payfor loss. or damage fh anyone occurrence until the arnnunt of loss or damage exceeds$500. We will then pay
the amount of loss or damagein excess of $500 up to th,oaplA atile tJrnlt of Insurance for the following enhangements::
1. Personal Effects and:Property of othe;e's
2. Valuable Papers and Records (other than Eieclroafe Data)
3. Property Off-:Promises (Including Laptops and .Ether EtECtronic Equipm@nt) -
4. Outdour Property (,Iafned Perils)
5. Accounts Receivable
6.. Property in Transit (including Laptops and Otner:t_.tpotronic.Equipmeiit)
7. Fsne:Aits
Page 22 of 2S: Ir2lud.e co0yrighreUrlatprfal:oflr8uraace serycel. Offioe,,.Irc..81d 110 97 67 1(t 10
Ame: ican~ssos!atlon.oi: !rsurance;5ervices; !rte:. witttthelir perrMss!on .
Beecher Carlson 3/28/2013 1:33:11 PM PAGE 1/006 Fax Server
BEECH ER-, °!"~.ARLSON
Insurance Agency LLC
FAX TRANSMITTAL
LAR51544675BD17
Date: 3/28/2013 1:32:22 PM Num of Pages: 6
(including
cover)
To: Kariann Olson From: Larry Thompson
Company: Direct Phone: (541)494-2657
Phone: Direct Fax: (541)772-3785
Fax 5414885320 Email Address: larry.thompson@beechercarlson.com
3256 Hillcrosi Park Drive. Medford, OR 97504 (541)772-1111 Main (541)772-3785 Fax
CA License #OF09618 OR License #816307 WA License #252204
h:, iacm Ir .iossa~io in .a il:da; rt!;el ^1n] is intrncec Yely to Il t use: el n e ind idcr,'1 r3mad eC,Wx It 'w ro n l inlooced
nl.rrm1, ,1 wr..; sp iulY dr x,<]i.1 ii =r if LOlly info 1 -mi r- ifu n1 YCV a1 u tr€ ad i 1 1a- an w 1 patio 1 11:dWn or
q t p_a Of thi n my 11in i- 11GhiYntn. if "o u Y C m 1d if in r.( n do i:.nn it Yiy ::ntl F i^a liY: @a nnndnr
hnnlf-d Ewl ,i¢I.;;tu , and-afwn tY, orig a1 a, 11r;:ranini,si,:1 Is U, 1r.1,r by 1a,