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HomeMy WebLinkAboutInsurance Certificate: Adroit Construction I ® DATE (MM/DDIYYYY) AC40 o CERTIFICATE OF LIABILITY INSURANCE 2/27/2015 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: CT Susan Wilson 3256 Hitlcrest Park Drive a ONE Ex W 541-494-2658 A/C No : 541-494-2758 Medford, OR 97504 E-MAIL ADDRESS: swllson bbnw.com INSURER(S) AFFORDING COVERAGE NAIC # www.bbnw.com INSURER A : The Phoenix Insurance Company 25615 INSURED INSURER B : Travelers Property Company 25674 Adroit Construction Company, Inc. INSURER C : Liberty Insurance Underwriters 19917 Adroit Construction PO Box 609 INSURER D : SAIF Corporation 52412 Ashland OR 97520 INSURER E : Columbia Casual Company INSURER F : Western Sure Company COVERAGES CERTIFICATE NUMBER: 23634531 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 INSD WVQ POLICY NUMBER MMIDDIYYYY MMI DIYYYY LIMITS LTR A COMMERCIAL GENERAL LIABILITY ✓ DTC01E789762COF15 3/1/2015 3/1/2016 EACH OCCURRENCE $ 1,000,000 DAMAGE CLAIMS-MADE ❑ OCCUR PREM SES~ a oNcuEr ante $ 300,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY 17,11 JECOT 1:1 LOC PRODUCTS - COMP/OPAGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY DT8101 E78976TIL15 3/1/2015 3/1/2016 CO acBCINE LIMIT $ 1,000,000 ✓ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS DAMAGE NON-OWNED (Per $ HIRED AUTOS AUTOS Medical Pa ments $ 5,000 C UMBRELLA LIAB ✓ OCCUR 1000003444607 3/1/2015 3/1/2016 EACH OCCURRENCE $ 25,000,000 ✓ EXCESS LIAB CLAIMS-MADE AGGREGATE $ 25,000,000 DED RETENTION $ $ D WORKERS COMPENSATION 810619 10/1/2014 10/1/2015 ✓ SPER TATUTE OERH AND EMPLOYERS' LIABILITY - -A ANY PROPRIETOR/PARTNEPU EXECUTIVE YIN 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 E Professional Liability 2054097995 3/1/2015 3/1/2016 Limit: $2,000,000 (Retro Date - 3/1/2004) Deductible: $15,000 F BOLI Bond-Statutory 58637462 5/10/2014 5/10/2015 Limit: $30,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Project - Building Repairs to Fire Station #1. General Liability includes Additional Insured Coverage, Primary & Non-Contributory per attached endorsement CGD2460805 when required by written contract - Subject to policy terms, limits, conditions and exclusions. CERTIFICATE HOLDER CANCELLATION of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Attn: Kari Olson/Purchasing Representative THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN At At Avenue ACCORDANCE WITH THE POLICY PROVISIONS. 90 N Mountain Ashland OR 97520 AUTHORIZED REPRESENTATIVE Susan Wilson ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD CERT NO.: 23634531 CLIENT CODE: 04716 Susan Wilson 2/27/2015 9:50:03 AM (PST) Page 1 of 3 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED - (Section ll) is amended c) The insurance provided to the additional in- to include any person or organization that you sured does not apply to "bodily injury" or agree in a "written contract requiring insurance" "property damage" caused by "your work" to include as an additional insured on this Cover- and included in the "products-completed op- age Part, but: erations hazard" unless the "written contract a) Only with respect to liability for "bodily injury", requiring insurance" specifically requires you "property damage" or "personal injury"; and to provide such coverage for that additional insured, and then the insurance provided to b) If, and only to the extent that, the injury or the additional insured applies only to such damage is caused by acts or omissions of "bodily injury" or "property damage" that oc- you or your subcontractor in the performance curs before the end of the period of time for of "your work" to which the "written contract which the "written contract requiring insur- requiring insurance" applies. The person or ance" requires you to provide such coverage organization does not qualify as an additional or the end of the policy period, whichever is insured with respect to the independent acts earlier. or omissions of such person or organization. 3. The insurance provided to the additional insured 2. The insurance provided to the additional insured by this endorsement is excess over any valid and by this endorsement is limited as follows: collectible "other insurance", whether primary, a) In the event that the Limits of Insurance of excess, contingent or on any other basis, that is this Coverage Part shown in the Declarations available to the additional insured for a loss we exceed the limits of liability required by the cover under this endorsement. However, if the "written contract requiring insurance", the in- "written contract requiring insurance" specifically surance provided to the additional insured requires that this insurance apply on a primary shall be limited to the limits of liability re- basis or a primary and non-contributory basis, quired by that "written contract requiring in- this insurance is primary to "other insurance" surance". This endorsement shall not in- available to the additional insured which covers crease the limits of insurance described in that person or organization as a named insured Section III - Limits Of Insurance. for such loss, and we will not share with that b) The insurance provided to the additional in- "other insurance". But the insurance provided to „ the additional insured by this endorsement still is sured does not apply to bodily injury, prop- excess over any valid and collectible "other in- surance", whether primary, excess, contingent or of the rendering of, or failure to render, any on any other basis, that is available to the addi- professional architectural, engineering or sur- tional insured when that person or organization is veying services, including: an additional insured under such "other insur- I. The preparing, approving, or failing to ance". prepare or approve, maps, shop draw- 4. As a condition of coverage provided to the ings, opinions, reports, surveys, field or- additional insured by this endorsement: ders or change orders, or the preparing, approving, or failing to prepare or ap- a) The additional insured must give us written prove, drawings and specifications; and notice as soon as practicable of an "occur- II. Supervisory, inspection, architectural or rence" or an offense which may result in a claim. To the extent possible, such notice engineering activities, should include: CG D2 46 08 05 ® 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 CERT NO.: 23634531 CLIENT CODE: 04716 Susan Wilson 2/27/2015 9:50:03 AM (PST) Page 2 of 3 COMMERCIAL GENERAL LIABILITY 1. How, when and where the "occurrence" any provider of "other insurance" which would or offense took place; cover the additional insured for a loss we II. The names and addresses of any injured cover under this endorsement. However, this persons and witnesses; and condition does not affect whether the insur- ance provided to the additional insured by Ill. The nature and location of any injury or this endorsement is primary to "other insur- damage arising out of the "occurrence" or ance" available to the additional insured offense. which covers that person or organization as a b) If a claim is made or "suit" is brought against named insured as described in paragraph 3. the additional insured, the additional insured above. must: S. The following definition is added to SECTION V. 1. Immediately record the specifics of the - DEFINITIONS: claim or "suit" and the date received; and "Written contract requiring insurance" means ii. Notify us as soon as practicable. that part of any written contract or agreement The additional insured must see to it that we under which you are required to include a receive written notice of the claim or "suit" as person or organization as an additional in- sured on this Coverage Part, provided that soon as practicable. the "bodily injury" and "property damage" oc- c) The additional insured must immediately curs and the "personal injury" is caused by an send us copies of all legal papers received in offense committed: connection with the claim or "suit", cooperate a. After the signing and execution of the with us in the investigation or settlement of contract or agreement by you; the claim or defense against the "suit", and otherwise comply with all policy conditions. b. While that part of the contract or d) The additional insured must tender the de- agreement is in effect; and fense and indemnity of any claim or "suit" to c. Before the end of the policy period. Page 2 of 2 ® 2005 The St. Paul Travelers Companies, Inc. CG D2 46 08 05 CERT NO.: 23634531 CLIENT CODE: 04716 Susan Wilson 2/27/2015 9:50:03 AM (PST) Page 3 of 3