Loading...
HomeMy WebLinkAboutInsurance Certificate: Knife River Materials (2) DATE 22013 nMIADDNYYY) ACQRO® CERTIFICATE OF LIABILITY INSURANCE 17/12/2013 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 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 CONTACT Marsh USA Inc. - NAME: 333 South 7th Street, Suite 1400 PHONE AIC No Minneapolis, MN 55402-2400 EMAIL Attn: ccntractLmimCSS@marsh.com ADDRESS: INSURERS AFFORDING COVERAGE NAIC d J43750-LTNLGAWX-14-15 2010 2037 LTMMe At Y INSURER A: Liberty Mutual Fire Ins Co 23035 INSURED LTM, R INSURER B : Associated Electric 6 Gas Ins Services Ltd 3190004 DBA KNIFE RIVER VER MATERIALS BA KATERIALS INSURER C :Liberty Mutual Insurance Company 23043 PO BOX 1145 INSURER D: MEDFORD, OR 97501 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: CHl-W4334737-11 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 ADOL SUER POLICY NUMBER MM DD/YYYY M LTR M DDIYYYY LIMITS A GENERAL LIABILITY TB2-041-005097-044 0110112014 01/01/2015 EACH OCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY PRREMISE BENT ante $ 500,000 CLAIMS-MADE In OCCUR MED EXP Anyone mon) $ 10,000 X PER PROJECT AGGREGATE PERSONAL a ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMPIOP AGG $ 4.000.000 POLICY PRO- LOC $ JECT AUTOMOBILE LABILITY A12-64"05097-054 0110112014 0110112015 COMBINED SINGLE LIMIT 2,000,000 A Ea aocidem X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS X HIRED AUTOS X AUTOSWNEO PPReOPPERB DAMAGE $ $ B UMBRELLA LAB OCCUR XL5063403P 01/01/2014 0110112015 EACH OCCURRENCE $ 5,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DIED RETENTION$ $ C WORKERS COMPENSATION WC7-641-005097-024 (Guar. Cost) 0110112014 0110112015 vvc STATdU oTH- AND EMPLOYERS' LIABILITY G ANY PROPRIETORIPARTNERIEXECUTIVE YIN WA7.64D'005097-014 (ADS) 01101/2014 0110112015 E.L. EACH ACCIDENT $ 1.000'000 Mandatory 'n NH ) EXCLUDED? ~ NIA 'Includes'StOpGap' 1,000,000 E. L. DISEASE - EA EMPLOYE $ U. yes, das ce under 1,000,000 DESCRIPTION OF OPERATIONS hel. E.L. DISEASE- POLICY LIMIT $ T DESCRIPTION OF OPERATIONS I LOCATIONSI VEHICLES (Attach ACORD 101, Additional Remarks Schedule, IT mom space Is required) Re: All Operations City of Ashland islare induced as additional insured per the allached CG 2010 and CG 2037 endorsements and does not include professional liability coverage. Blanket Additional Insured for Automobile Liability is included per attached designated Insured Endorsement CA 2046. Excess liability applies to general liability, products and coo pleted operations, automobile liability, and employers liability. CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Altn. Kan Olsen THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 90 N. Mountain ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukhedee -~'t.auoo~%- cJ•w,~e.~ ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD Policy Number AI2-641-005097-054 Issued by LIBERTY MUTUAL FIRE INSURANCE COMPANY 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 TRUCKERS 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 PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART COMMERCIAL LIABILITY- UMBRELLA COVERAGE FORM Schedule Name of Other Person(s).[ Email Address or mailing address: Number Days Notice: Organization(s): Per schedule of certificate 90 holders on file with the company 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 above. We will send notice to the email or mailing address listed above at least 10 days, or the number of days listed above, 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. „ All other terms and conditions of this policy remain unchanged. LIM go 01 05 11 © 2011 Liberty Mutual Group of Companies. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Policy Number TB2-641-005097-044 Issued by LIBERTY MUTUAL FIRE INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ R 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 TRUCKERS 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 COMMERCIAL LIABILITY - UMBRELLA COVERAGE FORM Schedule Name of Other Person(s) ! Email Address or mailing address: Number Days Notice: Organization(s): Per schedule of certificate 90 holders on file with the coma n 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 above. We will send notice to the email or mailing address listed above at least 10 days, or the number of days listed above, 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. All other terms and conditions of this policy remain unchanged. LIM 99 01 05 11 © 2011 Liberty Mutual Group of Companies. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 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. 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 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 hate nor negate cancellation of the policy. SCHEDULE Name of Other Person(s) I Email Address or mailing address: Number Days Notice: Organization(s): Per schedule of certificate holders on file with the company 90 All other terms and conditions of this policy remain unchanged. Issued by Liberty Insurance Corporation For attachment to Policy No. WA7-64D-005097-014 Effective Date 01/0112014 Premium $ Issued to WM 90 18 06 If © 2011 Liberty Mutual Group of Companies Page 1 of 1 Ed. 06/01/2011 All Rights Reserved 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. 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 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): Per schedule of certificate holders on file with the company 90 All other terms and conditions of this policy remain unchanged. Issued by Liberty Insurance Corporation For attachment to Policy No. WC7-641-005097-024 Effective Date 01/01/2014 Premium $ Issued to AM 90 18 06 11 © 2011 Liberty Mutual Group of Companies Page 1 of 1 Ed. 06/01/2011 Al Rights Reserved POLICY NUMBER: AI2-641-005097-054 COMMERCIAL AUTO CA 20481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement., This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not after coverage provided in the Coverage Form. SCHEDULE Name Of Person(s) Or Organization(s): Any person or organization whom you have agreed in writing to add as an additional insured, but only to coverage and minimum limits of insurance required by the written agreement, and in no event to exceed either the scope of coverage or the limits of insurance provided in this policy This policy will be primary and non-contributory to any like insurance available to the person or organization noted above. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.I. of Section II - Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I - Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 1013 0 Insurance Services Office, Inc., 2011 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: All persons or organizations with whom you have entered into a written contract or agreement, prior to an "occurrence" or "offense", to provide additional insured status and specifically requiring this version of the endorsement. (if no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section 11 - Who Is An Insured is amended to (1) All work, including materials, parts or include as an insured the person or organization equipment furnished in connection with shown in the Schedule, but only with respect to such work, on the project (other than liability arising out of your ongoing operations per- service, maintenance or repairs) to be formed for that insured. performed by or on behalf of the addl- B. With respect to the Insurance afforded to these tional insured(s) at the site of the cov- additional insureds, the following exclusion is ered operations has been completed; added: or 2. Exclusions This insurance does not apply to "bodily inju- ry" or "property damage" occurring after: CG 20 10 10 01 © ISO Properties, Inc., 2000 Pagel of 2 (2) That portion of "your work" out of which the injury or damage arises has been put to. its intended use by any person. or organization other than another con- tractor or subcontractor engaged in performing`operations for a principal as a part of the same project. This endorsement Is executed by the. LIBERTY MUTUAL FIRE INSURANCE COMPANY Premium $ Effective Date Expiration Date For attachment to Policy No. TB2-641-005097-044 Audit Basis Issued To Countersigned by Authorized Representative Issued Sales Office and No. End. Serial No. Page 2 of 2 @ ISO Properties, Inc., 2000 CG 20 10 10 01 E3 POLICY NUMBER: TB2-641.005097-044 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENTCHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Section 11 - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury' or "property dam- age" caused, in whole or in part, by "your work" at the location designated and described in the sched- ule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations All persons or organizations with whom you have All locations as required by a written contract or entered into a written contract or agreement, prior to an agreement entered into prior to an "occurrence" or 'occurrence' or offense, to provide additional insured offense, status. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. CG 2D 37 07 04 C ISO Properties, Inc., 2004 Page 1 of 1