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HomeMy WebLinkAboutInsurance Certificate: Lomakatsi Restoration Project ACS ® DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 4/15/2015 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 CONTACT NAME: - Protectors Insurance, LLC PHONE 41-77 - Ac No : 541-772-1906 P.O. Box 4669 E-MAIL Medford OR 97504 ADDRESS:I rl r r in m INSURERS AFFORDING COVERAGE NAIC # INSURER A : AI Corporation INSURED LOMAK-1 INSURER B :First National Insurance o 4724 Lomakatsi Restoration Project INSURER C:American States of Texas Justin Cullumbine INSURER D :American States Ins Company 19704 PO Box 3084 Ashland OR 97520 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBED: 210359168 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 LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS B GENERAL LIABILITY 25CC1600449 /17/2015 /17/2016 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $1,000,000 CLAIMS-MADE a OCCUR MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 RO- LOC Loggers Broad Form $1,000,000 POLICY F P JECT C AUTOMOBILE LIABILITY 04CC2285275 /17/2015 /17/2016 Ea acccidentSINGLE LIMIT $1,00 '000 ANY AUTO BODILY INJURY (Per person) $ ALL OWNED X SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS AUTOS Per accident $ D UMBRELLA LIAB X OCCUR 01 SU43335510 /17/2015 /17/2016 EACH OCCURRENCE $2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED X RETENTION $ 10,000 $ A WORKERS COMPENSATION 992153 4/1/2015 /1/2016 WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT i $ OFFICER/MEMBER EXCLUDED? ❑ N/A E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) As additional insured per policy endorsement CG7635(0207): CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main St Ashland OR 97520 AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD • , Insurance COMMERCIAL, GENERAL L[ABiLITY (b) This insurance does not apply to This exdusfon applies even It the alarms CG 76 35 02 or 'bodily Injury' or 'property dam- against any Insured allege negligence or age' arising out of the We neg5- orJhef wrongdoing In the scpesvisi n, Nfing, genie of such person or employment, training or rrorAor{n9 of others organization; by that heured, 4 the "occurrence' which ~;y Injury" or *property the THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. `acaused (4) Pefmi+s issued by any eats or p~xiacal damage' hrvolved the o•nnErs7ap, mair;te- sub*Asion with respect to operations nance, use or er1Prustment to o'!7Ws of any LIABILITY PLUS ENDORSEMENT Wormed by you or on your behalf, ekeraft, 'auto' or watercra9 that Is ovened subject to Via following additional pro, or operated by or rented or Ioar*d to are,< M, ls?on: cured. This endorsement mod~ftey insurance, provided urufer the fdsawtng- urThis insurance does not apply to Ud,'Iy This exclusion does not apply to: COW,IERCIAL GENERAL LMILITY COVERAGE PART Injury', 'property damage,, or (1) A watercraft elide ashore on pram?ses 'personal and advertsing injury' arising you cmq or rent; SCHEDULE out of operations performed for the s+a!e y or mun ipafty. (2) A wa ercfaft you do not assn that !s: Less than 52 feet fan and Name of Person or Ofganlzatton: c. The Insurance with respect to any arch sect, (a) g: engineer, or surveyor added as an insured (b) Not being used to carry persons or by tits endorsement does not apply to property for a charge; BLANKET - PER CERTIFICATE OF INSURANCE roodlj kgvey', 'property damage', or Wr- sonal and adverting injury' arising out of (3) Parking an 'au',o' on, or on the ways the rendering of or the fakure to reoxder arty next to, prehhses you own or rent, pro- professlor a services by or for you, includ- vkfed the 'auto' Is riot Owned by or Ing. rented or bared to you or t va k%sured; (1) The Preparing, approving. or tailing to (4) LlabT y assumed under any `dnsured prepare or approve naps, drawings, contrail' for the a,Mrshp• ma'nte- opinlons, reports, surveys, change or- nance or use of afrcra`t or v,aterua't; or ADDITIONAL INSURED BY WRITTEN lease or ocovpy, subject to ft foL'oxln dens, designs or speceficat ohs; and (s) h3odgy injury' or 'proprrrj da Wage" CONTRACT, AGREEMENT OR PERMIT, OR &Mdonalprovislons: g (2) Supervisary, laspection or englneernng arisingoucof. SCHEDULE services. (a} fie operation of machinery or (a) Ti's insurance does not apply to equipment that Is a.".ached to, or The folaw•Lng paragraph Is added to WHO IS All any "occurrence" wfuch taxes phce d. Thx insurance does not apply to todiPrr of, a tand vetrcle that Mould after you cease to be a tenant h injury" or 'property darnaga' ty hided wthin quar L~SURED (Section Il): dy selector the de'n+'-0n of any prerrtlses leased to cr rented to tee '~voducts-corrpteted operations haz- 'mobile equipment` 0 It were not 4. A77y person or oigaNlzatfon shave In the Sched- Y°ui wd'• stared to a compulsory or financial ula or for whom you are required b~ written con- (b) This Insurance does rat apply to respons blrty law Or Other motor ve- tract, agreement or perrrA to prov;da insurance any structural akeratiorts, rt-wr con- A person's or om}aniza on's -status as an Insured un• Ncie insurance law In the state is an hhsured, subject to the fotloktng addtional st"bon or demotition operators der this Endorsement ends when your operations for v.,here it Is licensed or prine;pa!fy provislons pedomted by or on behalf of the that Insured are comp%-!ed. garaged: or e. The Contrail, agreEntcnt or permit must be parson or orgartination added as an (b) tha operation of arry of the mach!,n- fn effect during the policy period shown In Insured; No coverage wit be provided If, In the absence of this ery of equipment 1"sted to Paragraph the Declarations, and must have been oxen (2) Your ongo=.ng operators for that In endarsamrit no WaNT-ty would be Imposed by lave on f.(2) or f.{3) of the da~nton of euted rkv to the 'both in you- Coverage shag be rbmiled to the extent of your •moblo of nnt'. damage", or 'personal and advertising sw you or for u+vora 6 performed nag genie or fa~~t sccord-q to leis eppl cable prEncl ~ Injkrry•, by Y you; p[es of campara'ive fault. (b) An aircraft you do not o~vn pro•;.dad it Is (3) The maWenance, operation or use by net operated by are/ Inivred, b. The parson of organization added as an ILr- you of equipment leased to you by such NON-OWNED WATERCRAFT AND NON-OWNED BRfTY cured t7y 0-ifs endorsement is an Insured only person or organuzaton, subject to the AIRCRAFT LIABILITY TENANTS' PROPERTY DAMAGE LfA to thQ extent you ere held liable due to: folowing aMtfonal provisions' (1) The ownersh)p, m Wenance or use of (a) This Insurance does not eppfy to Exclusion g. of COVERAGE A (Sect;on 1) Is fWaced When a Damage To Prernses Rented To You Limit 15 that part of premises you Own, rent, any 'occurrence` which Lakes place by the folioMng: shown in the Declarat;ons, Exciu slon of Gmc-raga after the equipment Lease Mx res; A, Section I Is repraCed by the following. g. 'Bod1y Injury" or 'property damage' arising out of the ownerhlp, rrabl.enanre, use of Damage To Property mtrstmem to others of arty a:'.fCraft, 'auto` 'Property damage' to, or watercralt ovmed or operated by or rented Inctudes Copyrighted Material of Insuranco Services Offce, ink„ with Its permisslon, or loaned to any Insured. Use Indudes open- (1) Property you own, rent, or occupy, Includaxg Copyright, Insurance Services, 2001 atbn sett loading or unloading', any costs or expenses Incurred by you, or St- w t. sem se- C.P wr n 03 76 35 C2 V Pk4 I d t E? Prc 2dr CG7635(0207) pdf CG7635(0207) pdf any other person, organization or entity, for WHO IS AN INSURED MANAGERS EXTENDED DEFINITION OF BODILY INJURY Inter repair, rep>acerrent, enhancement, res3ora- p,a only by a s coat roadvay. w3 envoy, or ton of mal-4enance of such property for any The fotlaaing Is added to Paragraph 2.a, of WHO IS Para r3ghirof way of a railroad. reason, Inckdng prevention of injury to a AN INSLiREO (Section 11j: graph 3, of DEFt.ITTt}`LS (Becton Y) Is replaced person or damage to anther's property by the foffarrtng INCREASED f:EEO1CAt EXPENSE LIMIT (2) Premises you sell, give away or abandon, if Paragraph (1) does not apply to execu'Jve officets, or 3, 'Bodily fryuy * wears boouq trhj;nry, slckrtass a The Medical the 'property damage' arises out of any part to managers at the sUP00, Lsory level or above. disease sustained by e person. Including mental t xpense un T Is amended to $10,DO0. 01 those premises; angush or death resuftng from arty of these at KNOWLEDGE OF OCCURRENCE (3) Property loaned to u; SUPPLEMENTARY PAYMENTS - COVERAGES A any time, Yo AND B - BAIL BONDS - TIME OFF FROM The following Is added to Paragraph 2. De*s In The (4) Personal property hh the care, custody or WORK TRANSFER OF RIGHTS OF RECOVERY ENmnt Ot Occurrence, Offense, Cla1m Or Suit of oontrol of ttm Insured; l -MMEROAL GF~.ERAL LIAP)UTY COr:OMU S Paragraph 1.b, of SUPPLEMENTARY PAYMEt{TS - The following is added to Paragraph a TranVer Of (Section M: {5} That ! cvlar Part of real Property on which COVERAGES A AND 8 Is replaced by the following: Rights Of Recovery Agalnst O'Jhers To Us of CO-% you or airy contractors of subcontractors MERCIAL GENERAL. LIABILITY CONOTTt NS (Sao working drectly or h,dnectfy on your behalf b, Up to $3,WO for cost of baT bonds reguIred tion I Kra1{edge of an `cccurrence•, cfatm or `su'et' by are because of accidents w traffic taw violat-orts your agent, servant or employee shall rat In Itse4 pe wis g operations. if the . or ty arilIng out Of the Use of any vettlde io wfVch µ!e vraive a constitute Lgww' of the named Insured unless an damagee" ' arises out of thO;r3 opars`.;ohsns a n the Barry injury Llab&ty Carerags apprYs. ! r ghs o! recovery r.a may hav a age nst officer of the named insured has recelv*d such notice (6) That particuTaf part of arry property that mLrst We do not have to furnish these bonds. any person of orgaw7atfon bbecatse of payments we from the agent, servant or em i:,Ioyee. be restored, repaired or replaced because make for Injury or danago arising out of your ongoing your worts' was Incorrectly performed on k. Paragraph 1.d. of SUPPLEMENTARY PAYLTLNTS operations or 'your work' done under a Contract with UNINTENTIONAL FAILURE TO DISCLOSE ALL Para n hs 1 , 3 and 4 of this exclusion do CAVERAGES A AhD B is repfaced by the fotuovrln that person or orgarolza6on and IrxArded let the HAZARDS g ap { } g 'products-corrple.ed operations hazard', This vra,rer not fly to 'property damage" (other than d. All reasonab'•e expenses bicurred by the in- app(es only to a person or organization for wfiom you The foffo+,ing b added to Paragraph 6. RReppresc,-i+a- damge by fire) to premises, Including the Corr cured at our request to assist us In the Inn are regtyred by va ten conlrac~ agreement or pecrrA ,ions of Ca IMERCiAL GENERAL L MSMI-Y CON01- tents of such premises, rented to you. A separate vesvvggon or defense o! the claim or 'suit`, to valve these nights of recovery. TTONS (Section IV): Emit of insurance applies to Damage To Preen- Including actual loss of earnfrtgs up to S500 Ises Rented To You as described trt Section IIi a day because of time Of from wor'K. AGGREGATE LIMrTS OF INSURANCE - PER ii ou unln!en5ona'l fall to crscloze air! hazards ex- - Lim its Of Insurance, Y y LOCATION Utkhg at trio bxeption date of your po?icy, r.e will not Paragraph (2) of this exclusion does rot apply It EMPLOYEES AS INSUREDS - HEALTH CARE deny coverage under thfs Co.waga Form because of tha premises are yarc work' and were never SERVICES For all suns v;hlch the insured becomes legs:°j ob'i- such fasure. Hcrtvover, this punision does not affect occupied, rented or held for rental by you. gated to pay a3 damages caused by 'occurre'hces' our right to co[fed add Joni premier.-rt or exercise our Paragraphs (3), (4)), (56) and d (S} of tilts exciusfon Provision 2.a(1)(d) of WHO IS A~i INSURER (Section undar COVERAGE A (Section 1), and for all medial right of cance',rahon or non-re-newel. do r 4. 11) 1s deleted, unless excluded by separa-e endorse- expenses caused by accidents under C<WERAGE C epplY to (y a(6) ci under a side' mWL (Section i), atich can be attrbvtod only to operations LIBERALIZATION CLAUSFE track agreement at a single location": Paragraph (6) of this exclusion does not apply to WENDED COVERAGE FOR NEWLY ACQUIRED The following paragraph Is added to CO^. MEROAL 'property damaga• Included In &,a 'products. ORGANIZATIONS Paragraphs 2.a. and 2.b. of Limits of insurance (Sea GENERAL LIA&LITY COND11-04S (Section IV): completed operations hazard', Son Ili) apply separate.'y to each of your 'Ioca5orts' Provisfon 3,a of WHO IS AN iNSURED (SecEan 11) Is armed try or rented to your. 10, if a res ision to thfs Coverage Part, which would Paragraph B. of LJMTS OF INSURANCE (Section iif) replaced by the Wo lIng: provide more cavefage with no a6tlonaf pre- Is replaced by the following a. Coverage tinder !iris prowls fln s afforda `Location" means premises InvoNfng the sama or rriurn, becomes e.YerWa during the policy pcnod connecting lots, or Frernises vfitase connecC~on Is In the sa.e shown In the Declarations. yrou7 pol- 6. Subject to s, rbove, the Damage To Premises only unO the end of the? pony period. Icy will automatically provide tlls atilt"onel cw,r- Rented To You Limit IS the most we will pay un EXTfNDEO `PROPERTY DAfLtAGE" efago on M effect}va da'e of the re,,Won. clef Coverage A fa damages because of 'property damage' to any one premises, While rented to you, or in the case of damage fry fire, Exclusion a- of COVERAGE A (Sector 0 is tepfaced while rented to you of temporenly oocupled by by the following: you with permissfon of the owner, a- '80th, r„ or ` ro dame jkTMY° P p~Y ge° expected The Damage To Premises Rented Ta You lmit Fs the or intended from 04 standpoint of the Insured. of higher of the Each Occurrence Umit shown In the or >is exGuslon dues not apply to the use use of Oeclatations or the amount shown In the Declarations reasonab?e ° ef force to p"rolet {e t P perer crasons m or the property. as Damage To Prefrtisas Rented To You Limn 07135nC7 ~3dk ~ Fit 1 d 1 " r•.r:7anrrrnnn nrii