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HomeMy WebLinkAboutInsurance Certificate: Carollo Engineers (2) CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 09/20/2014 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 NCONTACT AME: Marsh Sponsored Programs aoNN 1.877.320.9393 ac No : 515.365-0895 a service of Seabury & Smith, Inc. ADDRESS: riskmanagernenti@Wmarshpirn.com PO Box 14404 PRODUCER Des Moines, IA 50306.9686 CUSTOMER ID Vendor ID: 31459 INSURE S) AFFORDING COVERAGE NAIC # INSURED INSURER A : Old Republic Insurance Company 24147 Caroilo Engineers INSURER B : 4600 East Washington St., #500 INSURER C : Phoenix, AZ 85034 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 DDL UBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PR S ES-11 ccurrence) CLAIMS-MADE ❑ OCCUR MED EXP (Anyone person) PERSONAL & ADV INJURY GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG . POLICY F-1 . PRO- LOC $ AUTOMOBILE LIABILITY ! COMBINED SINGLE X ANY AUTO I, LIMIT (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY (Per person) $ A SCHEDULED AUTOS X X L437056.14 10117/2014 10!17/2015 BODILY INJURY (Per accident) $ PROPERTY DAMAGE HIRED AUTOS (Per accident) $ NON-OWNED AUTOS $ $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE DEDUCTIBLE RETENTION WORKERS COMPENSATION WG STATU- OTH- AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE ❑ OFFICERIMEMBER EXCLUDED? E.Z. EACH ACCIDENT _ (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE K yes, describe under DESCRIPTinN OF OPERATIONS below E.L. DISEASE -POLICY LIMIT LIT I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) GPBR: 2260 Policy provides protection for any & all operationsfJobs performed by the named insured where required by written contract. Certificate holler is an Additional Insured where required by written contract Waiver of Subrogation included where required by written contract. Insurance is primary and non-contributory. RE: Disinfection Byproduct Improvements. Project 2012-05. Caroilo Project 9228A.00. City of Ashland, Oregon, and its elected officials, officers, and employees are additional insured where required by written contract. CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 13E CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main Street AUTHORIZED REPRESENTATIVE j' Ashland, OR 97520 ~~~~z---- ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and loan ara rpaictarRd marks of OCnRr1