HomeMy WebLinkAboutInsurance Certificate: Kogap Enterprises (2) A CERTIFICATE OF LIABILITY INSURANCE DATE (MMNp YYY)
4/2/2014
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).
CONTACT
PRODUCER
Brown Brown Northwest Insurance NAME: Wlson
3256 Hil!crest Park Drive PHONE FAX
.IA/C No €Xtg 541- 494 -2658 IArc, No): 541-494-2758
Medford, OR 97504 EMAIL
ADDRESS: swilson(5/bbnw.com
INSURER(SI AFFORDING COVERAGE NAIC a
www.beechercadson.com INSURER A: American States Insurance Company 19704
INSURED INSURER B
Kogap Enterprises, Inc.
PO Box 1608 INSURER C:
Medford OR 97501 INSURERO:
INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER )9710194 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 ADDLI POLICY NUMBER SUBA POLI EFF POLICYEXP
INCt WV (MMNDM'YYI IMM/ODIYYYY)
LTR LIMITS
A ,2 COMMERCIAL GENERAL LIABILITY V 01C168337210 '4/12014 4/1/2015 EACH OCCURRENCE 1,000,000
CLAIMS -MADE I OCCUR P P R� S ES IEe oc a ence) S 1,000,000
MED EXP (Any one person) 10.000
I PERSONAL &ADV INJURY S 1.000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE IS 2,000.000
POLCY 1 1 J EO 1 I10c PRODUCTS. COMP/OPAGG 1 2,000.000
OTHER: I
A 71 AUTOMOBILE
AUTO unewTr
J 02CE22903810 4/1/2014 4/12 COMBINED SINGLE LIMIT
015 CO BINEDU S
ANY AUTO BODILY INJURY (Per person) 1,000,000
2UiO5 _�AU TOSULED `BODILY INJURY (Per accident)
I NON -OWNED i PROPERTY DAMAGE S
(_I HIRED AUTOS AUTOS �LPera
1 I I IUMMIM Liability S 1,000,000
A 2 UMBRELLAUAB 'I OCCUR 01SU4271522 4/1/2014 4/1/2015 EACH OCCURRENCE S 10,000,000
EXCESS LIAB CLAIMS -MADE AGGREGATE S 10,000,000
DELI 1 RETENTION 510,000 5
WORKERS COMPENSATION PER OTN-
AND EMPLOYERS' LIABILITY y IN STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE ri NIA E.L. EACH ACCIDENT S
OFFICER/MEMBER EXCLUDED?
(Mandatory N NH) E.L. DISEASE EA EMPLOYEE
IIyea. de ones.
INSCRIPTION OF OPERATIONS ceImv E.L. DISEASE POLICY LIMIT S
DESCRIPTION OF OPERATONSI LOCATIONS I VEHICLES (SCORE, 101 Additional Remab• Schedule. may he attached if mem apace is myuired)
Re: Sediment Removal at East and West Forks of Ashland Creek. General liability Policy includes Blanket Additional Insured coverage as required by
written contract per endorsement CG86741207 (attached). Subject to policy terms, conditions and exclusions.
CERTIFICATE HOLDER CANCELLATION
agents, CI Of Ashland, its a officers SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City 9 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
employees. ACCORDANCE WITH THE POLICY PROVISIONS.
20 E Main St
Ashland OR 97520
AUTHORIZED REPRESENTATIVE
I Susan Wilson
1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
CEPT NO.: 19710194 CLIENT CODE: 002602 Susan Wilton 4 /2/2014 8,29:13 M4 Page 1 of 3
COMMERCIAL GENERAL LIABILITY
CG 86 74 12 07
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CONTRACTORS LIABILITY PLUS ENDORSEMENT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
Any person or organization•for-whom you are required by written contract, agreement or
to provide additional insured endorsement.
DUTY TO DEFEND or B or medical expenses under COV-
ERAGE C.
Paragraph a. of SECTION I COVERAGE A and No other obligation or liability to pay sums or
COVERAGE B is replaced by the following: perform acts or services is covered unless ex-
a. We will pay those sums that the insured be- plicitly provided for under SUPPLEMENTARY
comes legally obligated to pay as damages PAYMENTS COVERAGES A AND B.
because of "bodily injury", 'property
damage" or 'personal injury and advertising EMPLOYERS LIABILITY
injury" to which this insurance applies. We
will have the right and duty to defend the in- The last paragraph of exclusion e. of SECTION I
sured against any "suit" seeking those dam- COVERAGE A is replaced by the following:
ages. Our duty to defend begins once you This exclusion does not apply to liability assumed
notify us of a "suit" as described in SEC-
TION IV COMMERCIAL GENERAL LI-
by the insured under an "insured contract" ex-
ABILITY CONDITIONS, 2.b. However, we cent for that part of a contract or agreement that
will have no duty to defend the insured indemnifies any person or organization for their
against any "suit seeking damages for sole liability.
"bodily injury", "property damage or
"personal injury or advertising injury" to WRONGFUL EVICTION
which this insurance does not apply. We
may, at our discretion, investigate any The following exclusion is added to SECTION I
"occurrence" and settle any claim or "suit" COVERAGE B:
that may result. But: The wrongful eviction from, wrongful entry into,
(1) The amount we will pay for damages is or invasion of the right of private occupancy of a
limited as described in SECTION III room, dwelling or premises arising out of any:
LIMITS OF INSURANCE; and
(1) "property damage" to the room, dwell
(2) Our right and duty to defend ends when ing or premises; or
we have used up the applicable limit of (2) "bodily injury" sustained through occu-
insurance in the payment of judgments pancy of a room, dwelling or premises.
or settlements under COVERAGES A
CG 86 74 12 07
CERT NO.: 19710194 CLIENT CODE: 002602 Susan Wilson 4/2/2014 8,29:13 AN Page 2 of
ADDITIONAL INSURED BY WRITTEN CON- This insurance does not apply to 'bodily
TRACT, AGREEMENT OR PERMIT, OR SCHED- injury", 'property damage or
ULE "personal and advertising injury" arising
out of operations performed for the state
The following paragraph is added to SECTION 11 or municipality;
WHO IS AN INSURED: c. The insurance with respect to any architect,
4. Any person or organization shown in the Sched- engineer, or surveyor added as an insured
ule or for whom you are required by written con- by this endorsement does not apply to
tract, agreement or permit to provide insurance bodily injury", "property damage or
is an insured, subject to the following additional "personal and advertising injury" arising out
provisions: of the rendering of or the failure to render
any professional services by or for you, in-
a. The contract, agreement or permit must be cluding:
in effect during the policy period shown in
the Declarations, and must have been exe- The preparing, approving, or failing to
cuted prior to the injury", 'property prepare or approve maps, drawings,
damage or "PC al and advertising opinions, reports, surveys, change or-
njury". ders, designs -or specifications; and
b. The person or organization added as an in- Supervisory, inspection or engineering
sured by this endorsement is an insured only services.
to the extent you are held liable due to: d. This insurance does not apply to "bodily
(1) The ownership, maintenance or use o f injury" or "property damage" included within
that part of premises you own, rent, the products- completed operations
lease or occupy, subject to the following hazard
additional provisions: e. A person's or organization's status as an in-
(a) This insurance does not apply to sured under this endorsement ends when
any "occurrence" which takes place your operations for that insured are com-
after you cease to be a tenant in pleted.
any premises leased to or rented to f. No coverage will be provided if, in the ab-
you; sence of this endorsement, no liability would
(b) This insurance does not apply to be imposed by law on you. Coverage shall
any structural alterations, new con- be limited to the extent of your negligence
struction or demolition operations or fault according to the applicable principles
performed by or on behalf of the of comparative fault.
person or- organization added as an g. The defense of any claim or "suit" must be
insured; tendered as soon as practicable to all other
(2) Your ongoing operations for that in- insurers which potentially provide insurance
sured, whether the work is performed for such claim or "suit
by you or for you; h. The insurance provided will not exceed the
(3) The maintenance._ operation or use .by lesser of_
you of equipment leased to you by such (1) The coverage and /or limits of this policy,
person or organization, subject to the or
following additional provisions:
(2) The coverage and /or limits required by
(a) This insurance does not apply to said contract, agreement or permit.
any "occurrence" which takes place
after the equipment lease expires; NON -OWNED WATERCRAFT AND NON -OWNED
(b) This insurance does not apply to AIRCRAFT LIABILITY
"bodily injury" or "property
damage" arising out of the sole Exclusion g. of SECTION I COVERAGE A is re-
negligence of such person or or- placed by the following:
ganization; "Bodily injury" g. y j ry" or "property damage" arising
(4) Permits issued by any state or political out of the ownership, maintenance, use or
subdivision with respect to operations entrustment to others of any aircraft, "auto"
performed by you or on your behalf, or watercraft owned or operated by or rented
subject to the following additional pro-
vision:
CERT ND /9710194 CLIENT CODE: 002602 Su san Wi150n 412/2014 8:19:11 AM Pane 3 of