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HomeMy WebLinkAboutInsurance Certificate: Green Meadows Building ® DATE MMrDD,YYYY) A~ CERTIFICATE OF LIABILITY INSURANCE 4/2/2013 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 policyCes) 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). CONTACI PRODUCER INSURANCE MARKETPLACE, INC- NAME: NAME: F A AC No: MONE PO BOX 278 ADDDDREM. MEDFORD, OR 975010019 INSURER(S) AFFORDING COVERAGE NAICe INSURER A: Contractors Bonding and Insurance Company 37206 INSURED NSURER B: GREEN MEADOWS BUILDING COMPANY INSURER C: 5313 HWY 66 NsuRER D: ASHLAND, OR 97520 IN SURER E: INSURER F: 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 WTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. P FF IFIMENUFFIR: R TYPE OF NSURANCE FOLICY NUMBER MMrnn Y M LIMITS A GENERALLMBILITY - EACH OCCURRENCE f 1,000,00 X COMMERCIALGENERALLIABIUTY D11PG0629 1/6/2013 1/612014 PREMISES Ea occurrence $ 300,00 CLAIMS-WIDE F-XIOCCUR MEDE(P(Anyone person) f 5,00 Y PERSONAL&ADVINJURY f 1,000,00 GENERALAGGREGATE f 1,000,00 GEN'L AGGREGATE LIMIT APFUES PER: PRODUCTS - COMP/OP AGO IF 1,000,00 X PWCV 'R LOC f COMBINED SINGLE LIMIT AUTOMOaaE NABa1TY amdeni f ANY AUTO BODILYINJURY(Perperson) S ALL OWNED SCHEDULID BODILY INIURV(Per arnden0 If AUTOS 0 ONNED PROPERTY DAMAGE f HIRED AJTOB AUTOS (Per ammentf UMaRE LLA LIAB OCCUR EACH OCCURRENCE f HE XCESS LIAB CLAIMS-NME 'AGGREGATE f DEC) RETENTIONS E WORNE AS COMPE NSATION WC STATU- OTH-CRY UM I R ANDEMPLOYERS'LIABWTY YIN f ANY PROPRIETORIPARTNERIEXECUTIVE❑ E.L EACH ACCIDENT NIA OFFICERMEMBER EXCLVDED4 (Mandatory in NH) EL DISEASE - EA EMPLOYE f IT yes, describe under DESCRIPTION OF CPERATIONSbebsr EL DISEASE - POLICY UMT E DESCRPTION OF OPERATIONS I LOCATIONS l VEHICLES (ARach ACORD 101, AddMonal Remarks Schedule, Nmore q=e is reeubed) CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED PER FORM CBGL0051 ATTACHED. Products and completed operations coverage is included according to the terms of the policy and subject to applicable policy exclusions. CERTIFICATE HOLDER CANCELLATION CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 7 n. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN \ ACCORDANCE WITH THE POLICY PROVISIONS. 20 E MAIN ST / } v AUTHORED REPRESENTATIVE ASHLAND, OR 97520 Gl~Jb! 139V ,1~~1 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26 (201 of06) The ACORDnameand logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: CITY OF ASHLAND (If no entry appears above, information required to complete this endorsement will be shown in the Decla- rations or Supplemental Schedule as applicable to this endorsement.) A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or or- ganization(s) shown in the Schedule. Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused by your negligence in the performance of your ongoing operations performed for that additional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. "Bodily injury", "property damage", or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, in- cluding but not limited to: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. 2. "Bodily injury" or "property damage" occurring after: a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or b. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. 3. "Bodily injury" or "property damage" occurring or commencing before: a. Execution of the written contract or agreement that such person or organization be added as an additional insured on your policy. - CBGL 00 51 06 06 Contains Copyrighted Material of Page 1 of 1 ISO Properties, Inc., with permission DATE(/02/13 t R CERTIFICATE OF LIABILITY INSURANCE OF ID DR FIDDPINNY) 0402 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 NAMWNIA~l E: Insurance Marketplace, Inc. aC, NO, Eat: (SIC, No): 1998 Skypark Dr Suite 100 ADDRESS: PRODUCE Medford OR 97504 C USTOMERIDII: GREEN-7 Phone:541-779-0177 Fax:FAX 772-8235 INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURER A: Saif Corporation - Green Meadows Building Co INSURER B: - Jim Green 5313 Hwy 66 INSURERC: Ashland OR 97520 INSURER D: INSURER E : INSURER F : 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 CONTACTOR 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. utn' LTR TYPE OF INSURANCE INSR WD POLICY NUMBER (MM/DDIYYYY) (MMIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) $ CLAIMS-MADE 0 OCCUR MED EXP (Any one person) $ PERSONAL $ADV INJURY $ GENERAL AGGREGATE $ GENT AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGO $ POLICY JECOT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE (Per accident) $ HIRED AUTOS NON-OWNED AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ S A WORKERS COMPENSATION 947168 01/01/13 01/01/11 TORWC ST Y LIMITS ER YIN AND EMPLOYERS' LIABILITY ANY PROPRIETORPARTNERIEXECUTIVF~, /A El. EACH ACCIDENT $ 500000 OFFICERMEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ 500000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, 'd more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITYOFA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland AUTHORIZED REPRESENTATIVE 20 E Main St Ashland OR 86520 R. Scott Weaver, CIC ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) - The ACORD name and logo are registered. marks of ACORD