HomeMy WebLinkAboutInsurance Certificate: Hukills Inc
DRA101 C OP ID: CDS
ACOR~ ` F DATE (MM/DDIYYYY)
CERTIFICATE OF LIABILITY INSURANCE 0312412015
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 NAME: Cindy Sorensen
United Risk Solutions, Inc. PHONE FAX
PO Box 936 AIC No Ext : 541-245-1111 ac, o,. 541-245-1112
Medford, OR 97501-0067 E-MAIL
SS: cindy.sorensen@unitedrisk.com
INSURER S) AFFORDING COVERAGE NAIC #
INSURER A: Gemini Insurance Company
INSURED Hukill's Inc., INSURER B: Mutual of Enumclaw 14761
dba Drainpros INSURER C:SAIF Corporation
P.O. Box 710
Eagle Point, OR 97524-0710 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 ADDL U R POLICY EFF POLICY EXP
TYPE OF INSURANCE POLICY NUMBER MM DDIYYYY MMDDIYYYY LIMITS
LTR
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00
A X COMMERCIAL GENERAL LIABILITY X VOGP001204 0410112015 04/01/2016 PREMISES Ea oc urrence $ 50,00
CLAIMS-MADE [K OCCUR MED EXP (Any one person) $ 5,00
PERSONAL & ADV INJURY $ 1,000,00
GENERAL AGGREGATE $ 2,000,00
GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00
X POLICY PRO LOC $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,009a accident $
B X ANY AUTO CPP001565801 04/0112015 04/01/2016 BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE
HIRED AUTOS AUTOS PER ACCIDENT $
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION $ $
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS' LIABILITY X TORY L MIT _ _ER_.
C ANY PROPRIETOR/PARTNER/EXECUTIVE YIN
N / A 787769 0910112014 0910112015 E.L. EACH ACCIDENT $ 500,00
OFRCERIAEMSER EXCLUDED? - - -
(Mandatory in NH) E,L. DISEASE - EA EMPLOYEE $ 500,00
If yes, describe under 500,00
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)
The City of Ashland is Additional Insured as provided by Endt. CG2033 04/13.
CERTIFICATE HOLDER CANCELLATION
CITAS01
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CI Of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
90 N. Mountain Ave.
Ashland, OR 97520-2014 AUTHORIZED REPRESENTATIVE
A
ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
Policy: VOGP001204 CG 20 33 04 13
Insured Name: HUKILL'S INC
Number: 19 Effective Date: 04/0112014
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - AUTOMATIC STATUS WHEN
REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU
This endorsement modifies insurance provided under the following:
Commercial General Liability Coverage Part
A. Section II - Who Is An Insured is amended to include as an additional insured any person or organization for whom
you are performing operations when you and such person or organization have agreed in writing in a contract or
agreement that such person or organization be added as an additional insured on your policy. Such person or organization
is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising
injury" caused, in whole or in part, by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your behalf,
in the performance of your ongoing operations for the additional insured.
However, the insurance afforded to such additional insured:
1. Only applies to the extent permitted by law; and
2. Will not be broader than that which you are required by the contract or agreement to provide for such additional
insured.
A person's or organization's status as an additional insured under this endorsement ends when your operations for that
additional insured are completed.
B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply:
This insurance does not apply to:
1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure
to render, any professional architectural, engineering or surveying services, including:
a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surreys, field
orders, change orders or drawings and specifications; or
b. Supervisory, inspection, architectural or engineering activities.
This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision,
hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury"
or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the
failure to render any professional architectural, engineering or surveying services.
2. "Bodily injury" or "property damage" occurring after:
a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other
than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of
the covered operations has been completed; or
b. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any
person or organization other than another contractor or subcontractor engaged in performing operations for a
principal as a part of the same project.
CG 20 33 04 13 1 of 2