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HomeMy WebLinkAboutInsurance Certificate: Gage It Construction LLC GAGEOIC OP ID: SHJ ) CERTIFICATE OF LIABILITY INSURANCE 0 D3110//2014 2014 03/10 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 endorsements . PRODUCER Phone: 541-245-1111 CONTACT Nikki Russell NAME: United Risk Solutions, Inc. PHONE FA% PG BOX 936 Fax: 541-245-1112 N E1115411-245-1111111 uC No: 541-245-1112 Medford, OR 97501-0067 EMAIL ADDRESS: nikki.russell@unitedrisk.com INSURERS AFFORDING COVERAGE NAIC If INSURER A: Western National Assurance Co 24465 INSURED Gage N Construction LLC INSURER B: P.O. Box 3483 Central Point, OR 97502-0018 INSURERC: 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 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 ADDL UB POUCYNUMBER MMODn`YN MMMDrfYP OMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X CPP 103630003 03/09/2014 0310912015 PREMISES Ea occurrence $ 300,00 CLAIMS-MADE I-XI OCCUR MED EXP (Anyone person) $ 10,00 PERSONALS ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 X POLICY F--IJFC.T E71 PRO LOC $ g MOBILE OABIOTY COMBINED SINGLE LIMIT 1,000,00 Ea accidentA ANYAUTO CPP 103629903 03/09/2014 03/09/2015 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident X UMBRELLA DAB X OCCUR EACH OCCURRENCE $ 1,000,000 A 1 EXCESS LIAR CLAIMS-MADE UMB 100639006 03/0912014 03/09/2015 AGGREGATE $ 1,000,00 DEC X RETENTION$ 10'000 $ WORKERS COMPENSATION WCSTATU- OTH. AND EMPLOYERS' UABIUTY YIN T RV LIMITS R ANY PROPRIETORrPARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICEWMEMBER EXCLUDED? ❑ NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ H yes, describe under DESCRIPTION OF OPERATIONSbelm E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) JOB: Guardrail City of Ashland is Additional Insured per form WNGL52 01/09. CERTIFICATE HOLDER CANCELLATION CITAS03 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y ACCORDANCE WITH THE POLICY PROVISIONS. 20 E Main Street Ashland, OR 97520-1814 AUTHORIZED REPRESENTATIVE aruNdCA~SP~Y~" ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD