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HomeMy WebLinkAboutInsurance Certificate: Knife River Materials I ® DATE (MM/DD/YYYY) 12/16/2014 ACORO CERTIFICATE OF LIABILITY INSURANCE THIS CERtiiFICATE 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: Marsh USA Inc. PHONE FAX 333 South 7th Street, Suite 1400 (A/C. No. ExtL ac No : Minneapolis, MN 55402-2400 AE"MAIL DDRESS: Attn: contract.reviewCSS@marsh.com INSURER(S) AFFORDING COVERAGE NAIC # J43750-LTWGAWX-15-16 2010 2037 LTMMe Al Y INSURER A : Liberty Mutual Fire Ins Co 23035 INSURED INSURER B : Associated Electric & Gas Ins Services Ltd 3190004 LTM,INCORPORATED DBA KNIFE RIVER MATERIALS INSURER C : Liberty Mutual Insurance Company 23043 PO BOX 1145 INSURER D : MEDFORD, OR 97501 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: CHI-004334737-13 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 LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A GENERAL LIABILITY TB2-641-005097-045 01/01/2015 01/01/2016 EACH OCCURRENCE $ 2,000,000 X DAMAGE TO RENTED 500,000 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE a OCCUR MED EXP (Any one person) $ 10,000 X PER PROJECT AGGREGATE PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 4,000,000 POLICY PRO LOC $ A AUTOMOBILE LIABILITY AI2-641-005097-055 0110112015 01/01/2016 =SINGLE LIMIT 2,000,000 Ea accident X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident B UMBRELLA LIAB OCCUR XL5063404P 01/01/2015 01/01/2016 EACH OCCURRENCE $ 5,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION $ $ C WORKERS COMPENSATION WC2-641-005097-025 (Guar. Cost) 01/01/2015 01/01/2016 X UVC STAT07 OTH- AND EMPLOYERS' LIABILITY I TORY LIMITS-L- I FR C ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N WA7-64D-005097-015 (AOS) 01/0112015 01/01/2016 E.L. EACH ACCIDENT 1,000,000 $ OFFICER/MEMBER EXCLUDED? N / A " (Mandatory in NH) Includes "Stop-Gap" E L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under 1,000,OlX) DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Re: All Operations City of Ashland is/are included as additional insured per the attached CG 2010 and CG 2037 endorsements and does not include professional liability coverage. Blanket Additional Insured for Automobile Liability is included per attached designated Insured Endorsement CA 20 48. Excess liability applies to general liability, products and completed operations, automobile liability, and employers liability. CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn: Karl Olsen THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 90 N. Mountain ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee _I xl u+ao►~+ +t+K[c ►ea . ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD