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Home My WebLink AboutInsurance Certificate: C-2 Utility Contractors A CERTIFICATE OF LIABILITY INSURANCE page l of 1 07/(15/21 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 NA,EACT Willis of Pennsylvania, Inc. PHONE FAX c/o 26 Century Blvd. C N XT: 877-945-7378 888-467-2378 P. 0. Box 305191 E6DRE certificates®tvillie. COID Nashville, TN 37230-5191 INSURER(S)AFFORDING COVERAGE NAICN INSURERA:Liberty mutual Fire Insurance Company 23035-001 INSURED C-2 Utility Contractors, LLC INSURER B: Liberty Insurance Corporation 92909-001 33005 Roberts Court INSURERC: Coburg, OR 97408 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 20116627 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. ILSR TYPE OFINSURANCE DO' SUB POLICY NUMBER MOLICYI POLICY EXP LIMITS A GENERALLIABILITI' y TB2631004260013 7/31/2013 7/31/2014 EACHOCCURRENCE S 5 Q00 00,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Eaoccureno. S 11000,000 CLAIMS-MADEFX-IOCCUR MED EXP(Anyone person) $ PERSONAL& ADV INJURY $ 51000,000 GENERAL AGGREGATE S 51000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG S 51000,000 POLICY X PRO- LOG A AUTOMOBILE LIABILITY AS2631004260023 7/31/2013 7/31/2014 COMBINED SINGLE LIMIT (Eeamident $ 5.000, 000 X ANYAUTO BODILY INJURY(Per person) S ALLOWNED 77SCHEOULED AUTOS AUTOS BODILY INJURV(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY AMA AUTOS Peraccitlent S UMBRELLA LIAB OCCUR EACHOCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE $ DIED RETENTIONS S B WORKERS COMPENSATION WA763DO04260033 7/31/2013 7/31/2014 X R I D' AND EMPLOYERS' LIABILITY B ANY PROPRI ETOR/PARTNER/EXECUTIVEY~ N/A WC7631004260043 7/31/2013 7/31/2014 E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMSER EXCLUDED? (Mandatory in NH) EI . DISEASE- EA EMPLOYEE $ 1,000,000 f yes, describe under DESCRIPTION OF OPERATIONS I E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (Attaca Acord 101, Additional Remarks Schedule, if more space Is required) Workers' Compensation in State of Washington is Self Insured. The City of Ashland and its elected officals, officers & employees are included as Additional Insureds as respects to General Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE City of Ashland 20 East Main Street L/fj..///rro Ashland, OR 97520 Coll:4155255 Tpl:1677939 Cert:20118627 01988-2010ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD Policy Number: TB2631004260013 & AS2631004260023 Endorsement Number: LA 99 224 09 10 Issued by: Liberty ;Mutual Fire Insurance Company & Liberty Mutual Fire Insurance Company Endorsement Effective Date: 7/31/2013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO THIRD PARTIES This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART MOTOR CARRIER COVERAGE PART GARAGE COVERAGE PART EXCESS AUTOMOBILE LIABILITY INDEMNITY COVERAGE PART SELF-INSURED TRUCKER EXCESS LIABILITY COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or organizations shown in the Schedule below. We will send notice to the email or mailing address listed below at least 10 days, or the number of days listed below, if any, before the cancellation becomes effective. In no event does the notice to the third party exceed the notice to the first named insured. B. This advance notification of a pending cancellation of coverage is intended as a courtesy only. Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy. SCHEDULE Name of Other Person(s) / Email Address or mailing address: Number Days Notice: Organization(s): City of Ashland 20 East Main StreetUAshland, OR 97520 30 All other terms and conditions of this policy remain unchanged. LA 99 224 09 10 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO THIRD PARTIES A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or organizations shown in the Schedule below. In no event does the notice to the third party exceed the notice to the first named insured. B. This advance email notification of a pending cancellation of coverage is intended as a courtesy only. Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy. SCHEDULE Name of Other Person(s) / Email Address or mailing address: Number Days Notice: Organization(s): City of Ashland 20 East Main StreetEl Ashland, OR 30 97520 WA7-63D-004260-033 (AOS) WC7-631-004260-043 (OR & WI) Effective: 7/31/2013 Expiration: 7/31/2014 All other terms and conditions of this policy remain unchanged. WM 90 18 09 10 2010 Liberty Mutual Group of Companies Page 1 of 1 Ed. 09/01/2010 All Rights Reserved