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HomeMy WebLinkAboutInsurance Certificate: Adroit Construction A. 1 CERTIFICATE OF LIABILITY INSUR0169 DATZE~i2()lIYY Y) THIS7CERTIFICA;E 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 endorsements . PRODUCER CONTACT Susan Wilson, AAI, AIC NAME: Beecher Carlson Insurance Agency LLC PHONE (541)772-1111 FAX .(591))72-3785 707 Murphy Rd MDDRLE .susan.wilson@beechercarlson.com INSURERS AFFORDING COVERAGE "IC M Medford OR 97504 INSURERA:Continental Insurance Company 35289 INSURED INSURER B:Libert Insurance Underwriters 19917 Adroit Construction Co INSURER C:SAIF Corporation 52412 PO Box 609 INSURER D;Columbia Casualty Company INSURER E: Ashland OR 97520 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1322625488 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 ADDL UBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MIDD YYY [MMIDDIYYYYJ LIMITS 1112L J= GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 X COMMERCIAL GENERAL LIABILITY PREMISES E ENcuen $ 300,000 A CLAIMS-MADE Fx1OCCUR 020534090 /1/2013 /1/2014 MED EXP(Any one person $ 5,000 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY X PRO LOC Pollution $ 11000,000 ECT F-] AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) 11000,000 A X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED 020534106 /1/2013 /1/2014 AUTOS AUTOS BODILY INJURY (Per accident) $ $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per cidenl Pollution Liability $ Include X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 15,000,000 B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 15, 000, 000 DED X RETENTIONS 000003444605 /1/2013 /1/2019 $ C WORKERS COMPENSATION X WC S T A T U T OTH- AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORIPARTNERIEXECUTIVE❑ NIA EL.ECH ACCIDENT $ - 500 000 OFFICERIMEMBER EXCLUDED'! 810619 10/1/2012 10/1/2013 (Mandatory In NH) E.L. DISEASE - EA EMPLOYE $ 500,000 H yes, describe under DESCRIPTION OF OPERATIONS helow E.L. DISEASE - POLICY LIMIT $ 500,000 D Professional Liability 86254097995 /1/2013 /1/2014 Limit: $2,000,000 Deductible: $15,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, N more space is re,ulred) Re: Hunter Park Project, Ashland, OR. General Liability Policy includes Blanket Additional insured and Primary/Non-Contributory Coverage as required by written contract per endorsement G-140331-C (attached). CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. Rari Olson, Purchasing Representative 90 N Mountain Avenue AUTHORIZED REPRESENTATNE Ashland, OR 97520 S Wilson, AAI, AIC/SU.~ ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 I= 005)901 The ACORD name and logo are registered marks of ACORD r CNR~ w (Ed. 1 (Ed. 10//10) 10) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - WITH PRODUCTS-COMPLETED OPERATIONS COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE (OPTIONAL) Name of Additional Insured Persons Or Organizations (As required by "written contract" per Paragraph A. below.) Locations of Covered Operations (As per the "written contract." provided the location is within the "coverage territory" of this Coverage Part) A. Section II - Who Is An Insured is amended to include 2. We will not provide the additional insured any as an additional insured: broader coverage or any higher limit of insurance 1. Any person or organization whom you are than the least that Is: required by "written contract" to add as an a. Required by the "written contract"; additional insured on this Coverage Part; and h. Described in 6.1.above; or 2. The particular person or organization, if any, scheduled above c. Afforded to you under this policy. . B. Tha insurance prnvided to tha additinnal insllrfxt is 3. This insurance is excess of all other insurance c limited as follows: available to the additional insured whether on a a primary, excess, contingent or any other basis. 1. The person or organization is an additional But if required by the "written contract," this $ insured only with respect to liability for "bodily insurance will be primary and non-contributory e injury," "property damage," or "personal and relative to insurance on which the additional advertising injury" caused in whole or in part by: insured is a Named Insured. a. Your acts or omissions: or 4. The insurance provided to the additional insured b. The ads or omissions of those acting on your does not apply to "bodily injury," "property behalf damage," or personal and advertising injury arising out of: ® In the performance of your ongoing operations specified in the "written contract"; or a. The rendering of, or the failure to render, any professional architectural, engineering, or c. "Your work" that is specified in the 'written surveying services, including: contract' but only for -bodily Injury or (1) The preparing, approving, or failing to "property damage° included in the "products- prepare or approve maps, shop drawings, completed operations hazard," and only if. opinions, reports, surveys, field orders, (1) The 'ritten contract' requires you to change orders or drawings and provide the additional insured such specifications; and ® coverage; and (2) Supervisory, inspection, architectural or c (2) This Coverage Part pruvides such engineering activities; or 0 coverage. G-140391-C IrrJudes LWyTgturd material ur Innurnnw Sewiws Orriw, Irn:., wM ila puninst3un Page 1 of 2 (Ed. 10/10) G-140331- (Ed.10/10) b. Any premises or work for which the additional We have no duty to defend or indemnify an insured is specifically listed as an additional additional insured under this endorsement until we insured on another endorsement attached to receive from the additional insured written notice this Coverage Part. of a claim or "suit." C. SECTION IV - COMMERCIAL GENERAL LIABILITY 2. With respect only to the insurance provided by this CONDITIONS is amended as follows: endorsement, the first sentence of Paragraph 4.a. 1. The Duties In The Event of Occurrence, of the Other Insurance Condition is deleted and Offense, Claim or Suit condition is amended to replaced with the following: add the following additional conditions applicable 4. Other Insurance to the additional insured: a. Primary Insurance An additional insured under this endorsement will This insurance is primary and non- as soon as practicable: contributory except when rendered (1) Give us written notice of an "occurrence" or excess by endorsement G-140331-C, or an offense which may result in a claim or when Paragraph b. below applies. "suit" under this insurance, and of any claim D. Only for the purpose of the insurance provided by this or "suit" that does result; endorsement, SECTION V - DEFINITIONS is (2) Except as provided in Paragraph B.3 of this amended to add the following definition: endorsement, agree to make available any "Written contract" means a written contract or written other insurance the additional insured has for agreement that requires you to make a person or gloss we cover under this Coverage Part; organization an additional insured on this Coverage (3) Send us copies of all legal papers received, Part, provided the contract or agreement: and otherwise cooperate with us in the 1. Is currently in effect or becomes effective during investigation, defense, or settlement of the the term of this policy and claim or "suit"; and (4) Tender the defense and indemnity of any 2. Was executed prior to: claim or "suit" to any other Insurer or self a. I he "bodily injury"or "property damage"; or insurer whose policy or program applies to a loss we cover under this Coverage Part. But b The offense that caused the "personal and if the 'written contract" requires this insurance advertising injury" to be primary and noncontributory, this for which the additional insured seeks coverage provision (4) does not apply to insurance on under this Coverage Part which the additional insured is a Named Insured. 0-140331-C Includes copyrighted material of Insurance 3ervims Office, Inc., with its permission Page 2 of 2 (Ed. 10/10)