HomeMy WebLinkAboutInsurance Certificate: Adroit Construction
~°~i~'~' RECORDER
'acoizv® CERTIFICATE OF LIABILITY INSURANCE 2/27/ Ti 2 2013
~ 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(les) 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 WCONTACT INE. S11san Wilson, AAI, AIC
FAX. No: (541)772-3785
Beecher Carlson Insurance Agency LLC (-.an.wilson@beechercarlsm.com
3256 Hillerest Park Drive PH°"E. stl san.wilson@beechercarlson.com
INSURE S AFFOROOIGCOVERAGE WIC0
Medford OR 97504 INSURERA Continental Insurance company 5289
INSURED INsuRERB Libert Insurance Underwriters 9917
Adroit Construction Co INSURERC:SAI£ Co ration 2412
PO Box 609 INSURERDColumbia Casualty
INSURERE:
Ashland OR 97520 INSURCRF:
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 MAYHAVE BEEN REDUCED BY PAID CLAIMS.
LTRR TYPE OF INSURANCE POLICY NUMBER MMIICYEFF WI D`YYY LIMITS I= JIM GENERAL LIABILITY X EACH OCCURRENCE F 1,000,000
X COMMERCIALGENERAL L ABILITY PREMISES Ee,Tence $ 300,000
A CLAIMS-MADE ❑X OCCUR 020534090 /1/2013 /1/2014 MED EXP(Any one person) $ 5,000
PERSONAL 8 ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 2,000,000
POLICY X PRO LOC $
AUTOMOBILE LIABILITY _ 1,000,000
A Ix ANVAUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED 020534106 /1/2013 /1/2014 BODILY INJURY(Per=iderd) $
AUTOS AUTOS
HIRED PUTOS X AUUTOS OVNED (Per ROPERT DAMAGE
X UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 15, 000, 000
B EXCESS UAB CLAIMS-MADE AGGREGATE $ 15,000,000
OED X RETENTION a 000003444606 /1/2013 /1/2014 $
* WORKERS COMPENSATION RSTATU- DEW-
AND EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIVE Ej NIA E.L. EACH ACCIDENT $ 1 000 000
OPTICERYMEMBER EXCLUDED? 10619 0/1/2013 On/2014
(Mentlrtoryln W() E.L. DISEASE - EA EMPLOYE $ 1,000,000
It Wyee, desm0e user
DESCRIPTION OF OPERATIONS Eebw EL DISEASE - POLICY LMIT Is 1 000 000
D Professional Liability PB254097995 /1/2013 /1/2014 Lima: $2,000,000
Deduo e. $15,000
DESCMPTION OF OPERATIONS I LOCATIONS I VEHICLES (AMO ACORD 101, AddIWal FMmerlu SO* We, Irmwe spxe lr required)
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 W
City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS.
Kari Olson, Purchasing Representative
90 N Mountain Avenue AUTIIURIZED REPFIESENTATVE
Ashland, OR 97520
S Wilson, AAI, AIC/SU 1-~• W-
ACORD 25 (2010105) OO 1888-2010 ACORD CORPORATION. All rights reserved.
INS025 (201005) 01 The ACORD name and logo are registered marks of ACORD