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HomeMy WebLinkAboutInsurance Certificate: Gage It Construction OP ID: SHJ CERTIFICATE OF LIABILITY INSURANCE D0AT3106D/YYYY) 03106/13 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 endorsement(s). PRODUCER 541-245-1111 CONTACT Nikki Russell N E: United Risk Solutions, Inc. PHONE FA% PO Box 936 541-245-1112 ac Na Ext:541-245-1111 AIC No) 541-245-1112 Medford, OR 97501-0067 E-MAIL ADDRESS: nikki.russell@unitedrisk.com PRODUCER ,GAG•ED1C• CU519 _ RJD INSURERS AFFORDING COVERAGE NAIC a INSURED Gage It Construction LLC INSURER A: Western National Assurance Co 24465 P.O. Box 3483 INSURER e : Central Point, OR 97502-0018 INSURER C INSURER D : INSURER E : NSURERF: 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 INSR MD ` U POLICY NUMBER MM1DDIYYYY MPOLICY EXP LTR MIDDNYVV LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X CPP103830002 03109113 03109114 OAMALET RfTEU- 300,000 PREMISES Ea $ occurmince) CLAIMS-MADE I-XI OCCUR MED UP (My one person) $ 10,000 PERSONAL S ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS -COMPIOP AGG $ 2,000,000 X r-1 JECT POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,098 A X ANY AUTO CPP103829902 03109113 03109114 (Ea acddentl BODILY INJURY (Per Person) $ ALLOWNEDAUTOS BODILY INJURY (Par accident) $ SCHEDULED AUTOS PROPERTY DAMAGE X HIREDAUTOS (Per accident) $ X NON-OWNEDAUTOS $ $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 A UMB100639002 03109113 03109114 DEDUCTIBLE $ X RETENTION $ 10,000 - - $ WORKERS COMPENSATION WC STATU. OTH- AND EMPLOYERS' LIABILITY YIN TQRYLI_MIT5 ER ANY PROPRIETORIPARTNERIEXECUTIVE E.L. EACH ACCIDENT $ OFFICEWMEMBER EXCLUDED? NIA (Mandatory In NH) E.L. DISEASE - EA EMPLOYE $ If es. describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) JOB: Guardrail City of Ashland is Additional Insured per form WNGL52 01109, attached. CERTIFICATE HOLDER CANCELLATION CITAS03 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 E Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520-1814 AUTHORUMD REPRESENTATIVE I ©1988.2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD