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HomeMy WebLinkAboutInsurance Certificate: Gage It Construction GAGE01 C OP ID: CDS ACORO' F DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 03/05/2015 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 endorsements . PRODUCER NAME: Nikki Russell United Risk Solutions, Inc. PHONE l: AIC, 541-245-1111 AX No ; 541-245-1112 PO Box 936 AIC No El Medford, OR 97501-0067 E-MAIL nikki.russell@unitedrisk.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Western National Assurance Co 24465 INSURED Gage It Construction LLC INSURER B : SAIF Corporation P.O. Box 3483 Central Point, OR 97502-0018 INSURER C : 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 ADDL SUBR POLICY NUMBER MM/DDYIYYYY MM DD/YYYY LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED 300 000 A X COMMERCIAL GENERAL LIABILITY X CPP103830004 03/09/2015 03/09/2016 PREMISES Ea occurrence $ ,CLAIMS-MADE 7XI OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 RO LOC $ X POLICY PJ CT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ A ANY AUTO CPP103829904 03109/2015 03109/2016 BODILY INJURY (Per person) $ X ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS NAUTOS ON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS PER ACCIDENT X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 A EXCESS LIAB CLAIMS-MADE UMB100639007 03/09/2015 03/09/2016 AGGREGATE $ 1,000,00 DED X RETENTION $ 10,000 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY TORY LIMITS X ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y 756250 05/01/2014 05/01/2015 E.L. EACH ACCIDENT $ 1,000,00 OFFICERIMEMBER EXCLUDED? N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ 1,000,00 I`' es, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) JOB: Guardrail City of Ashland is Additional Insured per form WNGL52 01/09. CERTIFICATE HOLDER CANCELLATION CITAS03 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y ACCORDANCE WITH THE POLICY PROVISIONS. 20 E. Main St. Ashland, OR 97520-1814 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD