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HomeMy WebLinkAboutInsurance Certificate: R and R Earthboring Inc ,arry Thompson BBNW (2/5) 05/12/2015 11:43:59 AM -070( DATE (h1M/DDIYYYY) ,4ORD CERTIFICATE OF LIABILITY INSURANCE F5/12/2015 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 NAMEADT Larry Thompson No : (541) 772-3785 Brown & Brown Northwest PHONE (541) 772-1111 AFAX (A/C No Ext)E-MAIL lthom son@bbnw. com 3256 Hillcrest Park Drive ADDRESS: p_ - INSURER(S) AFFORDING COVERAGE NAIC # Medford OR 97504 INSURERA American Hallmark Ins Co of TX 43494 INSURED INSURERB:SAIF Corporation 52412 R and R Earthboring Inc INSURER C: 85865 Hwy 99 S INSURERD: INSURER E : Eugene OR 97405 INSURERF: COVERAGES CERTIFICATE NUMBER:14-15 GL, BA, WC 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. POLICY EFT POLICY EXP rA TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DA"IAGE TO RENTED 100 , 000 CLAIM S4v1ADE X1 OCCUR PREMISES Ea o'cu rrence $ 44CL422029 10/14/2014 10/14/2015 MED EXP Any one person) $ 5,000 PERSONAL BADVINJURY $ 1,000,000 GEN'LAGGREGA -ELIMITAPPLIESPER GENERAL AGGREGATE $ 2,000,000 POLICY~ LJ PRJECOT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 X Employment Practices Liability $ 100 , 000 OTHER $ 1,000,000 AUTOMOBILE LIABILITY EaacB.ciderrt SINGLE LIMIT BODILY INJURY (Per person) $ A ANY AUTO ALL OWNED X SCHEDULED AUTOS AUTOS 44CL422029 10/14/2014 10/14/2015 BOD'LYINJURY (Peraccident) $ NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Peraccrdent)__ _ Medical payments $ 5,000 UED BRELLA LIAR H OCCUR EACH OCCURRENCE $ ESS LIAB CLAI AS-MADE AGGREGATE $ RETENTION $ $ WORKERS COMPENSATION STERAT OTH- UTE ER AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 500 , 000 OFFICERIMEMBER EXCLUDED? NIA B (Mandatory in NH) 624287 8/1/2014 B/1/2015 E.L. DISEASE - EA EIvt PLOYEE $ _ 500,000 If yes, describe under E.L. DISEASE -POLICY LI"" T $ 500 000 DESCRIPTION OF OPERATIONS helaw DESCRIPTION OF OPERATIONSI LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) General liability policy includes blanket additional insured per endorsement MP 9767 (attached), where required by written contract. This form is subject to policy terms, conditions, and exclusions. CERTIFICATE HOLDER CANCELLATION (541) 488-5311 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 East Main St. ACCORDANCE WITH THE POLICY PROVISIONS. . Ashland, OR 97520 AUTHORIZED REPRESENTATIVE Larry Thompson/LARRY © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (201401) ,arry Thompson BBNW (3/5) 05/12/2015 11:44:58 AM -070( e. E.7. Valuation of the BUILDING AND PERSONAL PROPERTY COVERAGE FORM is deleted and replaced bythe following: 7. Valuation We will determine the value of covered property in the event of loss or damage as follows: a. At actual cash value at the time of the loss (with a deduction for depreciation) except as provided in Paragraphs b, and c. following. b. Pair or Set. The value of a lost or damaged article which is part of a pair or set is based on a reasonable proportion of the value of the entire pair or set. The loss is not considered a total loss of the pair or set. c. Loss to Parts. The value of a lost or damaged part of an item that consists of several parts when it is complete is based on the value of only the lost or damaged part or the cost to repair or replace it. 2. Rental Reimbursement In the event of loss by a covered peril to covered contractors' equipment that you own, we will reimburse you for your expense to rent similar equipment while your equipment is inoperable. The most we will reimburse you for rental reimbursement expenses is $1,000. We will continue to reimburse you for the rental of equipment after the expiration date of this coverage provided the loss occurred before the expiration date. We will not reimburse you: a. If you can continue or resume your operations with similar equipment that is available to you at no additional expense to you; or b. For the rental expense of any equipment unless you make every reasonable effort to repair, replace or rebuild the inoperable equipment after the covered loss occurs. 3. With respect to this Additional Coverage, Contractors Equipment Coverage, Section D. Deductible of the BUILDING AND PERSONAL PROPERTY COVERAGE FORM is deleted and replaced by the following: D. Deductible We will not pay for loss or damage in any one occurrence until the amount of loss or damage exceeds $500. We will then pay the amount of loss or damage in excess of $500 up to the applicable limit of insurance. We will not reimburse you for the rental of equipment until after 72 hours have passed since the covered propertywas rendered inoperable. After 72 hours have passed, we will only reimburse you for the rental expense thatyou actually incur. The deductible of $500 does not apply to rental reimbursement expenses. General Liability Additional Coverages The following Additional Coverages are added to the COMMERCIAL GENERAL LIABILITY COVERAGE FORM. A. Blanket Additional Insured Coverage 1. SECTION 11- WHO IS AN INSURED of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM is amended to include as an insured any person or organization (referred to as Additional Insured) whom you are required to add as an Additional Insured on this policy under: a. A written contractor agreement; and b. Where a certificate of insurance showing that person or organization as an additional insured has been issued; and c. When the written contract or agreement and certificate of insurance are currently in effect or becoming in effect during the term of the policy and executed prior to the "bodily injury," "property damage," or "personal and advertising injury." 2. The insurance provided to the Additional Insured is limited as follows: a. The Additional Insured is only an additional insured for: (1) "Bodily injury," "property damage," or' personal and advertising injury" caused in whole or in part by negligent acts or omissions of the Named Insured or anyone directly or indirectly employed by the Named Insured or for whose acts a Named Insured may be liable. (2) Liability arising out of your ongoing operations for the Additional Insured by or for you. A person's or organization's status as an insured under this coverage ends when your operations for that insured are completed. b. The Limits of Insurance applicable to the Additional Insured are those specified in the written contract or agreement but not more than the Limits of Insurance specified in the Declarations for this policy. The Limits of Insurance Page 20 of 25 Includes copyrighted material of Insurance Services Office, Inc. and MP 97 67 10 10 American Association of Insurance Services, Inc., with their permission ,arry Thompson BBNW (4/5) 05/12/2015 11:46:08 AM -070( applicable to the Additional Insured are inclusive of and not in addition to the Limits of Insurance shown in the Declarations for the Named Insured. 3. In addition to the other exclusions applicable to Section I, Coverages A., B. and C. of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM, the insurance provided to the Additional Insured does not apply to: a. "Property damage" to: (1) Property owned, used, occupied by, loaned or rented to the Additional Insured; (2) Property in the care, custody or control of the Additional Insured or over which the Additional Insured are for any purpose exercising physical control; or (3) "Your work" performed for the Additional Insured. b. "Bodily injury," "property damage," or "personal and advertising injury" arising out of an architect's, engineer's or surveyor's rendering or failure to render any professional services for you, for the Additional Insured or for others, including, but not limited for (1) The preparing, approving or failure to prepare or approve maps, drawings, opinions, reports, surveys, change orders, designs or specifications; or (2) Supervisory, inspection or engineering services. c. "Bodily injury" or "property damage" occurring after: (1) 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 at the site of the covered operations has been completed; or (2) 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. 4. SECTION IV -COMMERCIAL GENERAL LIABILITY CONDITIONS, Paragraph 4. Other Insurance, is amended to add the following subparagraph: d. Additional Insured's Other Insurance As Excess Insurance To the extent required by an "insured contract," this insurance is primary on behalf of the Additional Insured; and any other insurance maintained bythe Additional Insured is excess and not contributory with this insurance. If the "insured contract" does not require this provision, then Paragraph a. above will apply. B. Mobile Equipment Broadened Coverage VA 2.f.(1) of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM is replaced by the following: (1) Equipment designed primarily for: (a) Snow Removal; (b) Road maintenance, but not construction or resurfacing; or (c) Street cleaning. Exceptthe above provisions do not apply to self-propelled vehicles of less than 1,000 pounds gross vehicle weightwhich are not intended for use on a highway. C. Aggregate Limit Per Project The General Aggregate Limit under SECTION 111 - LIMITS OF INSURANCE of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM applies separately to each of your projects away from premises owned by or rented to you. D. Blanket Waiver Of Transfer Of Rights Of Recovery Against Others To Us The Transfer Of Rights Of Recovery Against Others To Us Condition (SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against any person or organization to whom you by written contract or, written agreement have waived your own right or recovery for loss caused by that person or organization because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a written contract or written agreement with that person or organization and included in the "products-completed operations hazard." This provision does not apply unless the written contract orwritten agreement has been executed prior to the "occurrence" or offense giving rise to the "bodily injury" or "property damage." E. Voluntary Property Damage Coverage 1. We will, atyour request, pay but notdefend any claim for "property damage" to the property of others otherwise excluded under A.2.j.(4), (6) and (6) of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM provided that: MP 97 67 10 10 Includes copyrighted material of Insurance Services Office, Inc. and Page 21 of 25 American Association of Insurance Services, Inc., with their permission ,army Thompson BBNW (5/5) 05/12/2015 11:47:21 AM -070( a. Such "property damage" takes place while such property is in your care, custody or control, or is property of others over which you, for any purpose, are exercising or have exercised physical control; and b. Such "property damage" takes place away from any premises you own, rent or lease; and c. Such "property damage" takes place within the "coverage territory" and during the policy term; and d. Such "property damage" takes place only during Your operations that are known to us, are scheduled on the policy and for which a premium has been charged. 2. The insurance under this additional coverage does not apply to "property damage" to property: a. Held by you for servicing, repair, storage or sale at premises owned by, rented or leased to you; b. While being transported by or caused by the ownership, maintenance, operation, use, "loading or unloading" of any "auto," watercraft or aircraft; or c. Owned or occupied by or rented to you. 3. Deductible This additional coverage will apply only to that amount of any loss in each "occurrence" that exceeds $500. The terms of the policy with respect to your duties in the event of "occurrence," claim or "suit" and the Company's rightto investigate, negotiate and settle any claim or "suit" apply irrespective of the application of the deductible amount of $500. We may pay any part or all of the deductible amount of $500 to effect settlement of any claim or "suit." Upon notification of the action taken, you must promptly reimburse us for such part of the deductible amount as has been paid by us. 4. Limits of Liability The Limit of Liability for this additional coverage shall not exceed $2,500 for each "occurrence" and is the limit of the Company's liability for all damages on account of each claim or "suit" covered herein. The annual aggregate Limit of Liability is $2,500 and is, subject to the above provisions respecting each claim, the total limit of the Company's liability for all damages. 5. Settlement In the event of loss covered by this additional coverage, you shall, if requested by us, replace the property or furnish the labor and materials necessary for repairs thereto at actual cost to you, excluding prospective profitor overhead charges of any nature. Any property so paid for or replaced shall, at our option, become the property of the Company. Payment hereunder shall not constitute an admission of liability of you or, except as stated herein, of the Company. Additional Conditions A. Insurance Under Two Or More Coverages The following is added to Paragraph C. Insurance under Two or More Coverages of the COMMERCIAL PROPERTY CONDITIONS; If a Coverage Form is attached to this policy that provides a limit for any coverage provided by this endorsement; the limit shown in the SCHEDULE and the coverage provided by this endorsement are deleted and replaced by the limitand coverage provided by the Coverage Form. B. Limits Of Insurance Regard less of the number of buildings at a location covered by this endorsement, the most we will pay under this Coverage Enhancement endorsement in any one occurrence is the applicable Limits of Insurance shown in the SCHEDULE on page 1 of this endorsement. C. Deductibles The Deductible described in section D. ofthe BUILDING AND PERSONAL PROPERTY COVERAGE FORM applies to each of the Coverage Enhancements except as shown below: We will not pay for loss or damage in any one occurrence until the amount of loss or damage exceeds $500. We will then pay the amount of foss or damage in excess of $500 up to the applicable Limit of Insurance for the following enhancements: 1. Personal Effects and Property of Others 2. Valuable Papers and Records (Other than Electronic Data) 3. Property Off-Premises (Including Laptops and Other Electronic Equipment) 4. Outdoor Property (Named Perils) 5. Accounts Receivable 6. Property in Transit (Including Laptops and Other Electronic Equipment) 7. Fine Arts Page 22 of 25 Includes copyrighted material of Insurance Services Office, Inc. and MP 97 67 10 10 American Association of Insurance Services, Inc., with their permission