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HomeMy WebLinkAboutInsurance Certificate: Portland Engineering Inc (2) °RO® CERTIFICATE OF LIABILITY INSURANCE 6/25/2014 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 C ONTACT Kim Schnetzky NAME' Ward Insurance Agency PHONE (591)667-1117 FAC (541) 342-8280 PO Box 10167 E'MnIL .kim@wardinsurance. net INSURERS AFFORDING COVERAGE NAIC If Eugene OR 97440 INSURER A:Cincinnati Specialty 13037 INSURED INSURERB:Clncinnatl Insurance Companies Portland Engineering, Inc. INSURERC:Continental Casualty Company 7675 High Banks Road Suite 1 INSURER D: INSURER E : Central Point OR 97502 INSURER F: COVERAGES CERTIFICATE NUMBER:14/15 GL/AL/UMB/PROF/POLL 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 ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICYNUMBER MM/DDNYYY MMIDD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES rrence $ 100,000 A CLAIMS-MADE OCCUR X y 500039055 /1/2014 /1/2015 MED EXP(Any one person) $ Excluded X $1,000 BI/PD DED PERSONAL H AOV INJURY $ 1,000,000 PER OCCURR GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG $ 2,000,000 17 POLICY X PRO LOC WA STOP GAP LIABILITY $ 1,000,000 ECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ee accident 1 000 000 B ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED NP0148589 /1/2014 /1/2015 BODILY INJURY (Per acutlent $ AUTOS AUTOS ) NON-OWNED PROPERTY DAMAGE X HIREDAUTOS X AUTOS Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS DAB CLAIMS-MADE AGGREGATE $ 2,000,000 DED RETENTIONS S00039058 /1/2014 11 /1/2015 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N I TORY LIMITS ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? F---1 N/A E.L. EACH ACCIDENT $ (Mandatory in NH) EL.DISEASE-EAEMPLOVE $ It yes, describe under UESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ C PROFESSIONAL LIABILITY 6 CH288379629 /1/2019 /1/2015 LIMIT $2,000,000 POLLUTION LIABILITY DEDUCTIBLE $5,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Addiflonal Remarks Schedule, If more space is required) The City of Ashland, Oregon and its elected officials, officers and employees are named as additional insured as respects to work performed by the named insured under written contract agreement and per attached CSIA405-A. Completed operations apply per attached CSIA405-A. Coverage is primary 6 non-contributory per attached CSIA405-A. Waiver of subrogation is applicable per attached CSIA405-B. Designated construction project(s) general aggregate limit applies per attached CG2503. CERTIFICATE HOLDER CANCELLATION 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 E Main St. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE ~J M Holcomb/TRACEE ACORD 25 (2010105) © 1988-2010 ACORD CORPORATION. All rights reserved. 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O m C pNm n 8v ,ID-00 [mtm n DO 1 9 3m n$3 u_ Nr ro 9~+m' G< sa'9mRa 9 . ~1>,a '4u3 ommR sRg1 caaa E5° a =P"a J°n - SOU hm- mm _v hd 8 9Py yy~O ~O_ p c ci gL .oSN 88s.s8 mE w O m EoT~ .'Fm _ ~ °maEJ~ c £m m Jmy n~ m ~ o $ofmm$ am ° ~~'pC'lU vm _ a yy~C ~09F dm .gym E-; o .1 c a c ~ , lk. R CERTIFICATE OF LIABILITY INSURANCE 6/25/2DATE (MM DO014 14 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 NCONTACT AME: Kim Schnetzky Ward Insurance Agency PHONE. Exti. (541) 687-1117 AX Not. (541) 392-8280 PO Box 10167 EMAIL .kim@wardinsurance. net INSURERS AFFORDING COVERAGE NAIC I/ Eugene OR 97440 INSURER A:Cincinnati Specialty 13037 INSURED INSURER B-Cincinnati Insurance Companies Portland Engineering, Inc. iNSURERC:Continental Casualty Company 7675 High Banks Road Suite 1 INSURER D: INSURER E : Central Point OR 97502 INSURER F: COVERAGES CERTIFICATE NUMBER:14/15 GL/AL/UMB/PROP/POLL 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 L SUHR LTR TYPE OF INSURANCE POLICY NUMBER MM/DDY EYYY MMIDDNYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PDAMAG REMISE EaEOCCumsme $ 100,000 A CLAIMS-MADE OCCUR X Y S00039055 /1/2014 /1/2015 MED EXP Any one person) $ Excluded X $1,000 BI/PD DED PERSONAL B ADV INJURY $ 1,000,000 PER OCCURR GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS -COMPIOP ASS E 2,000,000 7 - POLICY X PRO LOC WA STOP GAP LIABILITY $ 1,000,000 IPCT El AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1 000 000 B ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED NP0148589 /1/2014 /1/2015 AUTOS AUTOS BODILY INJURY (Per accident) $ X HIRED AUTOS NON -OWNED PROPER-NAMAGE X AUTOS Per accitlent $ 8 X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 OEO RETENTIONS S00039058 11/1/2014 /1/2015 $ WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? r--1 NIA E. L. EACH ACCIDENT $ DESCRIPTION WC STATU- MT I (Mandatory in NH) E1, DISEASE - EA EMPLOYE $ yes. desc,nbe under OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ C PROFESSIONAL LIABILITY 6 CH288379629 /1/2014 /1/2015 LIMIT $2,000,000 POLLUTION LIAEILITY DEDUCTIBLE $5,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Ashland, Oregon and its elected officials, officers and employees are named as additional insured as respects to work performed by the named insured under written contract agreement and per attached CSIA405-A. Completed operations apply per attached CSIA405-A. Coverage is primary S non-contributory per attached CSIA405-A. Waiver of subrogation is applicable per attached CSIA405-B. Designated construction project(s) general aggregate limit applies per attached CG2503. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 20 E Main St Ashland, OR 97520 AUTHORIZED REPRESENTATIVE M Holcomb/TRACEE ACORD 25 (2010/05) © 1988.2010 ACORD CORPORATION. All rights reserved. INS025 (201005),Ol The ACORD name and logo are registered marks of ACORD N O P G O F E m r r o E 00 _ n$ - a E av m d A m 190+. O Q 3~ N U p~ _ N SLCC ydGY7 ~N WJ qC-G ~Sa° o>OT O c S E 6 ~u EJ Lm~ E AE ry Ua N d J 7 $ o o S z o8 °i cU m rzo n" w 0 mn E~aE°' E~~ do and @ c ~'W¢m a m8i K Z (n a; acaE EW.a N ay n T. boo v JV $-r-ao ,dg„ =ac mw t aO W F 6d E 'L' W d YLNN L~WC & -N GC P w N W Z~ ~$E r~ sa -i y W Fp- W W m~ ° g ~o~ A of dLg 8 u< n g,am -J EL Q U F W 0 -~n2- cg. 9. m~a LL EVEO m~°v .Wi.. a. (n W p a _m? 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