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HomeMy WebLinkAboutInsurance Certificate: Batzer Construction OP ID: RL ) CERTIFICATE OF LIABILITY INSURANCE 0 D5/01/12014 05/07 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). PRODUCER Phone: 503-224-2500 NCONTACT AME, Robin RG Guzman 1201 Anchor $W 12th Insurance Ave., , Suits 50Suretyty 0 AD No Inc Fax: 503-224-9830 PHONE Er503-224-2500 ac No: 503-224.9830 Portland, OR 97205-2030 E-MAIL John D. Klump PROOESS: rguzman@anchorias.com CUSTOMER ID a: BATZE-1 INSURERS AFFORDING COVERAGE NAIC0 INSURED Batzer Construction, Inc. INSURER A: Bituminous Casual Corp. 20095 PO Box 4460 INSURER 8: Illinois Union Insurance Co. 27960 Medford, OR 97501 INSURER C 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 POLICY NUMBER MM LTR IDDNYYY MMIDDrYYYY LIMITS GENERAL LABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X X CLIP 3603669 0510112014 05/01/2015 PREMISES Ea occurrence 300,00 CLAIMS-MADE FxIOCCUR MED EXP(Any one person) _ 5,000 PERSONAL S ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO $ 2,000,00 POLICY X PRO LOC $ -1 JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00 (Ea accident) A X ANY AUTO CAP 3603670 05/01/2014 05/01/2015 BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per accident) $ X NON-OWNEDAUTOS $ $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,00 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,00 A CUP 2 805 731 05/01/2014 05/0112015 DEDUCTIBLE $ X RETENTION $ 10,000 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LUIBILITY Y / N 1QRY LIMITS ANY PROPRIETORIPARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICERNEMBER EXCLUDED? El NIA (Mandatory In NH) E.L. DISEASE -EAEMPLOYEE $ It as, dascrita under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ B Professional Liab COO 023894956007 05/01/2014 05/0112015 Per Act 1,000,00 Pollution and EEO Aggregate 2,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remark; Schedule, If more space is required) RE! Ashland Electric Department Storage Project (E517-13) ADDITIONAL INSURED/WAIVER OF SUBROGATION: City of Ashland as required by written contract and per the terms/conditions of above General Liability Policy including the attached Endorsement GL-3084 (09/11). CERTIFICATE HOLDER CANCELLATION ASHLA-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main Street Ashland, OR 97520 AUTHORIZED REPRESENTATIVE ©1988.2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD POLICY k: CLP 3 603 669 ~ r THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ R CAREFULLY. BUILDERS EXTENDED LIABILITY COVERAGE This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM It is agreed that the provisions listed below apply only upon the entry of an Q in the box next to the caption of such provision. A. QX Partnership and Joint Venture Extension N. QX Construction Project General Aggregate Limits QX Contractors Automatic Additional Insured O. QX Fellow Employee Coverage Coverage - Ongoing Operations OR] Automatic Waiver of Subrogation P. 0 Property Damage Liability - Elevators D. QX Extended Notice of Cancellation, Nonrenewal O. Q Property Damage to the Named Insured's Work R. F- Care, Custody or control E. QX Unintentional Failure to Disclose Hazards S. ❑X Concrete Rework Labor Reimbursement F. QX Broadened Mobile Equipment Coverage G. Q Personal and Advertising Injury - Contractual T. FX Lost Key Coverage Coverage H. U. Q Electronic Data Liability Coverage X Nonemployment Discrlminatlon V. QX Consolidated Insurance Program Residual 1. r X Liquor Liability Liability Coverage J. F-X I Broadened Conditions W Q Automatic Additional Insureds - Managers or Lessors of Premises K. Q Automatic Additional Insureds - Equipment Leases X. QX Automatic Additional insureds - State or Governmental Agency or Political L. XQ insured Contract Extension - Railroad Property Subdivisions - Permits or Authorizations and Construction Contracts oY QX Contractors Automatic Additional Insured M. QX Turnkey Jobs - Coverage For Alienated Coverage - Completed Operations Premises Z. EX Additional Insured - Engineers, Architects or Surveyors A. PARTNERSHIP AND JOINT VENTURE EXTENSION The following provision is added to SECTION II - WHO IS AN INSURED: The last full paragraph which reads as follows: No person or organization Is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations. GL-3084 (09111) -1- Is deleted and replaced with the following: With respect to the conduct of any past or present joint venture or partnership not shown as a Named Insured In the Declarations and of which you are or were a partner or member, you are an Insured, but only with respect to liability arising out of 'your work' on behalf of any partnership or joint venture not shown as a Named Insured In the Declarations, provided no other similar liability Insurance is available to you for 'your work' in connection with your Interest In such partnership or joint venture. B. CONTRACTORS AUTOMATIC ADDITIONAL INSURED COVERAGE- ONGOING OPERATIONS SECTION iI - WHO IS AN INSURED Is amended to include as an additional insured any person or organization who is required by written contract to be an additional insured on your policy, but only with respect to liability for 'bodily Injury', 'property damage' or 'personal and advertising Injury' caused, In whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; In the performance of your ongoing operations for the additional insured(s) at the project(s) designated in the written contract. With respect to the Insurance afforded to these additional insureds, the following additional exclusions apply: This Insurance does not apply to 'bodily Injury' or 'property damage" occurring after: 1. All work, Including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional Insured(s) at the location of the covered operations has been completed; or 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 contractor or subcontractor engaged in performing operations for a principal as a part of the same project. This Insurance Is excess of all other insurance available to the additional Insured, whether primary, excess, contingent or on any other basis, unless the written contract requires this insurance to be primary. In that event, this Insurance will be primary relative to insurance policy(s) which designate the additional Insured as a Named Insured in the Declarations and we will not require contribution from such insurance if the written contract also requires that this Insurance be non-contributory. But with respect to all other Insurance under which the additional insured qualities as an Insured or additional Insured, this insurance will be excess. C. AUTOMATIC WAIVER OF SUBROGATION Item 8. of SECTION IV • COMMERCIAL GENERAL LiABILn Y CONDITIONS, is deleted and replaced with the following: 8. Transfer of Rights of Recovery Against Others to Us and Automatic Waiver of Subrogation. a. If the insured has rights to recover all or part of any payment we have made under this Coverage Form, those rights are transferred to us. The Insured must do nothing after loss to Impair those rights. At our request, the insured will bring 'suit' or transfer those rights to us and help us enforce them, b, If required by a written contract executed prior to loss, we waive any right of recovery we may have against any person or organization because of payments we make for Injury or damage arising out of "your work' for that person or organization. GL-3084 (09/11) -2- 1 This Insurance Is excess of all other insurance available to the additional insured, whether primary, excess, contingent or on any other basis, unless the written contract requires this insurance to be primary. In that event, this Insurance will be primary relative to Insurance policy(s) which designate the additional Insured as a Named Insured In the Declarations and we will not require contribution from such Insurance If the written contract also requires that this insurance be non-contributory. But with respect to all other Insurance under which the additional Insured qualifies as an insured or additional insured, this insurance will be excess. Y. CONTRACTORS AUTOMATIC ADDITIONAL INSURED COVERAGE- COMPLETED OPERATIONS SECTION II - WHO IS AN INSURED is amended to include as an additional Insured any person or organization who is required by written contract to be an additional Insured on your policy for completed operations, but only with respect to liability for 'bodily injury' or 'property damage' caused, In whole or in part, by 'your work' at the project designated in the contract, performed for that additional insured and Included In the 'products-completed operations hazard'. This insurance is excess of all other Insurance available to the additional insured, whether primary, excess, contingent or on any other basis, unless the written contract requires this insurance to be primary. In that event, this insurance will be primary relative to Insurance poltcy(s) which designate the additional Insured as a Named Insured in the Declarations and we will not require contribution from such insurance if the written contract also requires that this Insurance be non-contributory. But with respect to all other Insurance under which the additional insured qualities as an insured or additional insured, this Insurance will be excess. Z. ADDITIONAL INSURED - ENGINEERS, ARCHITECTS OR SURVEYORS SECTION 11 - WHO IS AN INSURED is amended to Include as an additional Insured any architect, engineer or surveyor who is required by written contract to be an additional insured on your policy, but only with respect to liability for 'bodily injury', 'property damage' or 'personal and advertising injury' caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; In the performance of your ongoing operations performed by you or on your behalf. This includes such architect, engineer or surveyor, who may not be engaged by you, but Is contractually required to be added as an additional Insured to your policy. With respect to the Insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does not apply to 'bodily Injury', 'property damage' or 'personal and advertising Injury' arising out of the rendering of or the failure to render any professional services, including: 1. The preparing, approving, or falling to prepare or approve maps, drawings, opinions, reports, surveys, change orders, designs or specifications; or 2. Supervisory, inspection or engineering services. This insurance Is excess of all other insurance available to the additional insured, whether primary, excess, contingent or on any other basis, unless the written contract requires this Insurance to be primary. In that event, this insurance will be primary relative to Insurance policy(s) which designate the additional insured as a Named Insured in the Declarations and we will not require contribution from such insurance if the written contract also requires that this insurance be non-contributory. But with respect to all other insurance under which the additional Insured qualifies as an insured or additional insured, this Insurance will be excess. GL-3084 (09111) -14-