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HomeMy WebLinkAboutInsurance Certificate: Knife River Materials (2) (MM/DD/YYYY) I ® 7126/2014 ACORO CERTIFICATE OF LIABILITY INSURANCE 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 CONTACT Marsh USA Inc. NAME: FAX PHONE 333 South 7th Street, Suite 1400 c 'C No): Minneapolis, MN 55402-2400 ADDRESS: Attn: contract.reviewCSS@marsh.com INSURERS 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-004334737-16 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 PREC~ F] O LOC $ A AUTOMOBILE LIABILITY AI2-641-005097-055 01/0112015 01/01/2016 COMBINED SINGLE LIMIT 2,000,000 Ea accident X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTO S AUTOS BODILY INJURY (Per accident) $ NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X 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) 01/0112015 01/01/2016 X WC sTATU- o C TH- AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y I N WA7-64D-005097-015 (AOS) 01/01/2015 01/01/2016 E.L. EACH ACLIM TER CIDENT $ 1,000,000 OFFICER/MEn NH) MBER EXCLUDED? N / A (Mandatoryi "Includes "Stop-Gap"' E L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I 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: Kan 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 E++ A- ' ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD Poiicy Number: Az G41-OGS-397--Orr Issued By: Liberty i-Tur_ua = Fire in~u.rance Co. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO THIRD PARTIES This endorsement modifies insurance provided under the following. BUSINESS AUTO COVERAGE PART MOTOR CARRIER COVERAGE PART GARAGE COVERAGE PART TRUCKERS COVERAGE PANT EXCESS AUTOMOBILE LIABILITY INDEMNITY COVERAGE PART SEI.PANSURED TRUCKER EXCESS LIABILITY COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERA T IONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART Schedule Dame of Other Person(s); Email Address or mailing Number Organization(s); address: Days Notice: Per schedule of rerti.fica.te holders Per schedule of certificate 17-tilde--o 90 on file with the Company or_ file wiLh the Company I - s _ If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or organizations shown in the Schedule above. We will send notice to the email or mailing address listed above at least 10 days, or the number of days listed above, if any, before the cancellation becomes effective. In no event does the notice to the third party exceed the notice to the first named insured. B. This advance notification of a pending cancellation of coverage is intended as a courtesy only. Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy. All other terms and conditions of this policy remain unchanged. LIM 99 41 05 11 C) 7011, Liberty Mutual Group of Companies. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office. Inc. with its permission, POLICY NUMBER: A12-641-005097- 055 COMWIRCIAL. AUTO CA 20481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIAR ILIT"Y COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Farm apply unless modified by the endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form, This endorsement does not alter coverage provided in the Coverage Form. SCHEDULE 1htarne Of Person(s) Or Organization (s)* Any person or organization whom you have agreed in writing to add as an additional insured. but only to coverage and minimum limits of insurance required by the written agreement and in no event to exceed either the scope of coverage or the limits of insurance provided in this policy. This policy will be primary and non-contributory to any like insurance available to the person or organization noted above. IJ l r - Information required to complete this Schedule, I not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A-1, of Section fl - Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I - Covered Autos Coverages of the Auto Dealers Coverage f=orm. CA 20 48 10 13 0 Insurance Services Office, Inc., 2011 page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL HABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Location(s) Of Covered Operations Or Organization s': Any persons or organizations for whom you have All locations as required in writing and agreed to agreed in writing, prior to an "occurrence" or prior to an "occurrence" or offense. "offense", to provide additional insured status. Information required to complete this Schedule. if not shown above, will be shown in the Declarations. A. Section 11 - Who 1s An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional exclu- organization(s) shown in the Schedule, but only sions apply: with respect to liability for "bodily injury" "property This insurance does not apply to "bodily injurY" or damage" or "personal and advertising injury" "property damage" occurring after: caused, in whole or in part, by: 3. Your acts or omissions; or 7 • All work, including materials, parts or equip- ment furnished in connection with such work, 2. The acts or omissions of those acting on your on the project (other than service,. maintenance behalf; or repairs) to be performed by or on behalf of in the performance of your ongoing operations for the additional insured(s) at the location of the the additional insured(s) at the location(s) desig- covered operations has been completed; or nated above. CG 2010 07 04 (D ISO Properties. Inc.; 2004 Page 1 of 2 2. That portion of "your work" out of which the iniury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project, This endorsement is executod by the LIBERTY FOUTUAL FIRE INSURANCE COMPANY Premium $ Effective Date Lxpiration Date For attachment to Policy No. TB2-641-005097-045 Audit Basis Issued To Countersigned by Authorized RepresenLatrtie Issued Sales Office and No_ End. Serial No. Page 2 of 2 Q iSO Properties, Inc., 2004 GG 20 IQ 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Operations Or Organization(s): Any persons or organizations for whom you have All locations as required in writing, and agreed to agreed in writing, prior to an "occurrence" or prior to an "occurrence" or offense. "offense", to provide additional insured status. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property darn- age" caused, in whole or in part, by "your work" at the location designated and described in the sched- ule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". This endorsement is executed by the LIBERTY MUTUAL. FIRE INSURANGE COMPANY Premium $ Effective Date Expiration Date For attachment to Policy No. 782-641-005097-045 Audit Basis Issued To Countersigned by Avthorze~ Represenlafiva Issued Sales Office and No. End. Serial No. CG 20 37 07 04 C7 ISO Properties, Inc., 2004 Page 1 of 1 Policy Number TB2-641-005097-0145 Issued by LIBERTY MUTUAL FIRE INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO THIRD PARTIES This endorsement modifies insurance provided under the fallowing: BUSINESS AUTO COVERAGE PART MOTOR CARRIER COVERAGE PART GARAGE COVERAGE PART TRUCKERS COVERAGE PART EXCESS AUTOMOBILE LIABILITY INDEMNITY COVERAGE PART SELF-INSURED TRUCKER EXCESS LIABILITY COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATICNS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART COMMERCIAL LIABILITY - UMBRELLA COVERAGE FORM - - Schedule Name of Other Person(s) I Email Address or mailing address: Number Days Notice. j ' Organization(s): Per Schedule of certificate 90 holders on file with the Company A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or organizations shown in the Schedule above. We will send notice to the email or mailing address listed above at least 10 days, or the number of days listed above, if any, before the cancellation becomes effective. In no event does the notice to the third party exceed the notice to the first named insured. B. This advance notification of a pending cancellation of coverage is intended as a courtesy only. Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy. All other terms and conditions of this policy remain unchanged. LIM 99 01 05 11 u 2011 Liberty Mutual Group of Companies. All rights reserved. Page 1 of 1 includes copyrighted material of insurance Services Office, Inc., with its permission. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO THIRD PARTIES A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or organizations shown in the Schedule below. We will send notice to the email or mailing address listed below at least 10 days, or the number of flays listed below, if any, before cancellation becomes effective. In no event does the notice to the third party exceed the notice to the first named insured. B. This advance notification of a pending cancellation of coverage: is intended as a courtesy only. Our failure ro provide such advance notification will not extend the policy cancellation: date nor negate cancellation of the policy. SCHEDULE Name of Other Person(s) ! Email Address or mailing address: Number Days Notice: Organization(s). Per schedule of certificate 90 holsters on file with the company. AI( other term; and conditions of this policy remain ranchanged. Issued by Liberty Insurance Corporation 21814 For attachment to Poky No. WA7-64D-005097-015 Effective Date 01,10'!20'5 Premium $ Issued to WM 90 18 06 11 Oc 2011 Liberty Mutual Group of Companies Page 1 of 1 Ed. 06l01i2011 All ;`tights Reserved NOTICE OF CANCELLATION TO THIRD PANTIES A. tf we cancel this policy fog- any reason rather than nonpayment of premium, we will notify the persons or organizations shown in the Schaau!e below. We will send notice to the email or mailing address listen beiovr at least 10 days, or the number of days listed below, if any, before cancellation becomes effective In no event does the nc°ice to the third part' exceFd the notice to the first named insured. E. This advance notification of a pending nanceltation of coverage is intender,' as a ccaurtes, y only. Our failure to provide sock advance notifl atior, will not extend, the policy cancellation date nor negate canceilatior of the policy. Schedule Name of Other Person(s) I Email Address or mailing address: Number Bays Notice: Organization(s); Oer s--hedule of cer'_ific•.ate holders on file with the company All other terms and conditions of this policy remain un :hanged. issued by Liberty IOufual Fire Insurance: Corrinany 16566 For attach, rkert to Policy No. VVC2-641-06097-1125 Effective Date Pr:mium $ issued to MDL' Resources Group. inc. 4b ~y WIVI 90 18 06 11 r' 01 Liberty Kill itual Group. l•1ii Rights Reserved. Pare 1 of 1 Fd. 06101/2011