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HomeMy WebLinkAboutInsurance Certificate: Ashland Construction (2) ACO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 9/20/2014 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 Brown & Brown Northwest NAME CONTACT Susan Wilson 3256 Hillcrest Park Drive A//CC. NO xs : 541-494-2658 a/c No : 541-494-2758 Medford, OR 97504 E-MAIL ADDRESS: Swilson bbnw.com INSURERS AFFORDING COVERAGE NAIC # www.bbnw.com INSURERA: Ohio Security Insurance Company 24082 INSURED INSURER B : Developers Surety & Indemnity Company Ashland Construction Inc Southern Oregon Concrete Pumping INSURER C : SAIF 102 Pleasant View INSURER D: Talent OR 97540 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 21660379 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DDIYYYY LIMITS A COMMERCIAL GENERAL LIABILITY ✓ BKS1556059356 3/21/2014 3/21/2015 EACH OCCURRENCE $ 1,000,000 DAMAGE T RENTED CLAIMS-MADE ✓ OCCUR PREMISES Ea occurrence $ 1,000,000 MED EXP (Any one person) $ 15,000 PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: 2,000,000 - GENERAL AGGREGATE $ ✓ POLICY F-] JECPROT D LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY BAS1554362629 3/21/2014 3/21/2015 EOa accINED SINGLE LIMIT g 1,000,000 ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS BODILY INJURY (Per accident) $ AUTOS NON-OWNED PROPERTY DAMAGE HIREDAUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ C ANWORKERS D EMPLO COMPENSATION ABILIITY YIN 469079 10/1/2014 10/1/2015 ✓ STA ER - TUTE EERH ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N / A (Mandatory In NH) E.L. DISEASE - EA EMPLOYE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 B CCB Commercial License Bond 274336C 711/2013 7/1/2015 Limit: $50,000 CCB Residential License Bond 274337C 7/1/2013 7/1/2015 Limit: $20,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION Cltyy SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 Eof Main Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN C ACCORDANCE WITH THE POLICY PROVISIONS. Ashland OR 97520 AUTHORIZED REPRESENTATIVE Susan Wilson ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD CERT NO.: 21660379 CLIENT CODE: 00012132 Susan Wilson 9/20/2014 11:31:30 AM (PDT) Page 1 of 1