HomeMy WebLinkAboutInsurance Certificate: Park Avenue Turf D:George Petersen Insurance Agency To:Renewal Certificates for Park Avenue TurF, Inc. (15414885320) 18:34 84/ EST Pg 2 -4
i f RECORDER PARKAVE -01 SFRUSHOUR
4CO CERTIFICATE OF LIABILITY INSURANCE DAE (mwoonn
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
NAME:
George Petersen Insurance Agency, Inc. PHONE ]g] 5254150 F 707 $2$417$
P.O. Box 3539 lac. No, Ezl): IA/C, Not
Santa Rosa, CA 95402 EMAIL
INSURER(S) AFFORDING COVERAGE NAIC a
INSURER A: Nationwide Agribusiness Insurance Company 28223
INSURED INSURER B: Pacific Compensation Insurance Company
Park Avenue Turf, Inc. INSURER C:
P.O. Box 2198 INSURER D
Sebastopol, CA 95473 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.
NSR TYPE OF INSURANCE ADDL SUBR POUCY EFF POUCY EXP
inn WYP POUCY NUMBER IMMNDIYYYY) (MMRIDIYYYY) OMITS
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000
CLAIMS -MADE X OCCUR X FPK7825544318 04/08/2014 04)08/2015 UAMAC,LIUU
PREMISES IEe NLNI accueerKe) S 100,000
MED EXP (Any one came) 5,000
PERSONALAADV INJURY 1,000,000
GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000
X POLICY I yra LOC PRODUCTS COMPiOPAGG S 2,000,000
OTHER: S
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT s 1,000,000
(Ea accident)
A X
ANY AUTO FPK7825544318 04/08/2014 04/08/2015 BODILY INJURY (Per palace) S
ALL OWNED SCHEDULED BODILY INJURY (Per
AUTOS AUTOS er eca0enf
NON -OWNED PROPERTY DAMAGE
HIRED AUTOS AUTOS (Per accident)
S
UMBRELLA LAB OCCUR EACH OCCURRENCE S
EXCESS LAB CLAIMS -MADE AGGREGATE S
DED RETENTIONS S
WORKERS COMPENSATION X PER OTH-
AND EMPLOYERS' LIABILITY STATUTE ER
B ANY PROPRIETOR/PARTNER/EXECUTIVE YIN WA -000511 -00 01/01/2014 01/01/2015 E.L. EACH ACCIDENT S 1,000,000
OFFCERAIENTER EXCLUDED? N
(Mandatory In NH) EL DISEASE EA EMPLOYEE S 1,000,000
n Yes. describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE POLICY LIMIT s 1,000,000
DESCRIPTION OF OPERATIONS LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may attached N more apace M repulred)
RE: Oak Knoll Golf Course.
The city of Ashland, Oregon, and its elected officials, officers and employees are named as Additional Insured with respect to General Liability per form CG 71
57 08 04 attached.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City Of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Attn: Karl Olson Purchasing Representative
90 N. Mountain Rd
Ashland, OR 97520 AUTHORIZED REPRESENTATIVE
O`• V U
Oo 1988 -2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
rge Petersen Insurance Agency To:Renewal Certificates for Park Avenue Turf, Inc. (15414885320) 18:34 04/08/14 EST Pg 1 -4
Attached are renewal certificates for Park Avenue Turf, Inc.
Tha nk you,
Shelley Frushour
Certificate Manager
George Petersen Insurance Agency
sfrushour @gpins.com
www.gpins.com
Phone: 707 -525 -2701
Fax: 707 -546 -9518
George Petersen Insurance Agency
and its Affiliates
Note: The information in this E -Mail message is confidential. It is intended solely for the use of the individual(s) named above. If you are the intended recipient,
be aware that your use of any confidential, proprietary and /or personal information may be restricted by state and federal privacy laws, If you are not the
intended recipient, you should not distribute or fonvard this E -mail message. If you have received this E -mail in error, please immediately notify the sender and
delete the material from any computer and /or server.
1
o:George Petersen Insurance Agency To:Renewal Certificates for Park Avenue Turf, Inc. (15414885320) 18:35 04/W/14 EST Pg 3 -4
COMMERCIAL GENERAL LIABILITY
CG7157
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED OWNERS, LESSEES OR CONTRACTORS
AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION CONTRACT
PRIMARY AND NON CONTRIBUTORY
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Section 11 Who Is An Insured is amended to 1. "Bodily injury", "property damage" or "personal
include as an additional insured any person or or- and advertising injury" arising out of the ren
ganization for whom you are performing opera- dering of, or the failure to render, any profes-
tions when you and such person or organization sional architectural, engineering or surveying
have agreed in a written contract that such person services, including:
or organization be added as an additional insured a. The preparing, approving, or failing to pre
on your policy. Such person or organization is an pare or approve, maps, shop drawings,
additional insured only with respect to liability for opinions, reports, surveys, field orders,
"bodily injury", "property damage" or "personal and change orders or drawings and specifica-
advertising injury" caused, in whole or in part, by: tions; or
1. Your acts or omissions; or b. Supervisory, inspection, architectural or
2. The acts or omissions of those acting on your engineering activities.
behalf; 2. "Bodily injury" or "property damage" occurring
in the performance of your ongoing operations after:
for the additional insured. a. All work, including materials, parts or
A person's or organization's status as an addi- equipment furnished in connection with
tional insured under this endorsement ends such work, on the project (other than ser-
when your operations for that additional in- vice, maintenance or repairs) to be per-
sured are completed. formed by or on behalf of the additional in-
No such person or organization is an addi- sured(s) at the location of the covered
tional insured for liability arising out of the operations has been completed; or
"products- completed operations hazard b. That portion of "your work" out of which the
injury or damage arises has been put to its
B. The following is added to SECTION III LIMITS intended use by any person or organization
OF INSURANCE: other than another contractor or subcon-
tractor engaged in performing operations
The limits of insurance applicable to the additional for a principal as a part of the same project.
insured are those specified in the written contract D. With respect to the insurance afforded to these
between you and the additional insured, or the lim- additional insureds, Condition 4. Other Insur-
its available under this policy, whichever are less. ance is replaced by the following:
These limits are part of and not in addition to the
limits of insurance under this policy. 4. Other Insurance
If other valid and collectible insurance is avail
C. With respect to the insurance afforded to these able to the insured for a loss we cover under
additional insureds, the following additional exclu- Coverages A or B of this Coverage Part, our
sions a PP y: obligations are limited as follows:
This insurance does not apply to:
CG 71 57 08 04 Includes copyrighted material of ISO Properties, Inc., with its permission. Page 1 of 2
a:George Petersen Insurance Agency To:Renewal Certificates For Park Avenue Turf, Inc. (15414885320) 18:36 04/08/19 EST Pg 4 -4
CG 71 57 08 04
a. Primary Insurance When this insurance is excess over other
This insurance is primary except when it is insurance, we will pay only our share of the
excess as provided under part b., below. amount of the loss, if any, that exceeds the
When this insurance is primary, we will not sum of:
seek contribution from other insurance (1) The total amount that such other in
available to the person or organization surance would pay for the loss in the
shown in the Schedule of this endorsement. absence of this insurance; and
b. Excess Insurance (2) The total of all deductible and self-
This insurance is excess over: insured amounts under all that other in-
(1) Any of the other insurance, whether surance.
primary, excess, contingent or on any We will share the remaining loss, If any, with
other basis: any other insurance that is not described in
(a) That is Fire, Extended Coverage, this Excess Insurance provision and was not
Builder's Risk, Installation Risk or bought specifically to apply in excess of the
similar coverage for "your work Limits of Insurance shown in the Declare-
tions of this Coverage Part.
(b) That is Fire insurance for premises
rented to you or temporarily occu- c. Method Of Sharing
pied by you with permission of the
owner; If all of the other insurance available to
(c) That is insurance purchased by you the additional insured permits contribu-
to cover your liability as a tenant for lion by equal shares, we will follow this
"property damage" to premises method also. Under this approach each
rented to you or temporarily occu- insurer contributes equal amounts until it
pied by you with permission of the has paid its applicable limit of insurance
owner; or or none of the loss remains, whichever
comes first.
(d) If the loss arises out of the mainte- If any of the other insurance available to
Hance or use of aircraft, "autos" or the additional insured does not permit
watercraft to the extent not subject contribution by equal shares, we will
to Exclusion g. of Section I op- contribute by limits. Under this method,
erage A Bodily Injury And Prop-
erty Damage Liability each insurers share is based on the ra-
When this insurance is excess, we will have do of its applicable limit of insurance to
the total applicable limits of insurance of
no duty under Coverages A or B to defend all insurers.
the additional insured against any "suit" if
any other insurer has a duty to defend the
additional insured against that "suit If no
other insurer defends, we will undertake to
do so, but we will be entitled to the addi-
tional insured's rights against all those other
insurers.
All terms and conditions of this policy apply unless modified by this endorsement.
Page 2 of 2 Includes copyrighted material of ISO Properties. Inc., with its permission. CG 71 57 08 04