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HomeMy WebLinkAboutInsurance Certificate: Little River Investments 0 DATE (MMIDDIYYYY) A`Cc~RD CERTIFICATE OF LIABILITY INSURANCE 5/28/LUlb 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(les) 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 Pam Dressler NAME~ NE Little River Investments PHO (541) 536-1726 AC No (541)536-1568 _LAIC No ExtS: - 51477 Hwy 97 ADDRESS:Pam@bancorpinsurance.com P.O. Box 327 INSURER(S) AFFORDING COVERAGE NAICB La Pine OR 97739 INSURERA 1'Maxum Indemnity Co. INSURED INSURERB:The Ohio Security_Insurance Compan 24082 Robert Jerome Keller, DDA: Oouthern Oregon Automatic INSURER C 200 Rogue Rim Dr INSURERD. INSURER E Merlin OR 97532 NSURERF: COVERAGES CERTIFICATE NUMBER:CL1552816604 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFF POLICY EXP LIMITS TR TYPE OF INSURANCE A POLICY NUMBER MMIDDIYYYY MMIDDIYYYY INSD X COMMERCIAL GENERAL LIABILITY EACH OCCURRE°dCE :f 1,000,000 7 Mf F TIG fITM fFE-MI_Eo Etc irronae $ 100, 000 A ~ CLAIMS PAADE ~ OCCUR ~ X BD00080293-02 5/2712015 5/27/2016 P,1EDEP{Anvonr1,,,[ on) 5,000 PERSGfIAL s AD / IPI,IUR 1 1,000,000 GElt ,ccRECr,TEUMITAP LIE£ ER C-EIIEI'`,L, GC _.;^:I6 9,no0,0n0 X PO L IU FRG- FROL,UCT~ ~ h1PIE-r h3G - 6 2,000,000 C I' JEC.T L-~ 5 UTHER AUTOMOBILE LIABILITY t,OM6INED HGE LI it 'Ea. "I lI, 1,000,000 ntl AN- AUTu LODILY IN.IURr Pei 1,rson) $ B qL OWNED LX AUTOS SCHEDULED AUTGo X BA855258496 10/10/2019 10/10/2015 EODIt IPIJURPIPtrNrIN-OWNED FROPERTY DAMAGE X HIREDAUTCS AUTOS PermcdenTry Lnwsurad motnnst wlnbined 1 1,000, 000 UMBRELLA LIAB ,0008 EACH OCCURRE'JCE $ EXCESSLIABCLAIMS -MADE AGi3REGATE ~ DED <ETENTIU11 WORKERS COMPENSATION PF:=z OTH- AND EMPLOYERS' LIABILITY YIN -T"TI ITE N"I PLOPHIE1 OhfDARTIII ~YLC1111 E N/A EL E =H a -fJT 0FFI(,ERIMEM6ER EXCLUDED? _ (Mandatory in NH) EL [.',AS[ E.1, EMPL_ PEE $ It yes, describe and r DESCRIPTION OF OPERATIONS below E L. DISEASE - FQL.ICY LIME( $ DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is listed as an Additional Insured per EN#MP97670408 attached. CERTIFICATE HOLDER CANCELLATION (541)488-5320 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Purchasing Representative ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Kari Olson 90 N Mountain Avenue AUTHURIZED REPRESENTATIVE Ashland, OR 97520 Pam Dr~ssler,!PD n 1988-201d ACORn CORPORATION All rights reservart ACORD 25 (2014/01) The ACORD name a,id logo are registered marks of ACORD INS025 {201401) COMMERCIAL GENERAL LIABILITY CG 20 33 04 13 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 B. With respect to the insurance afforded to these include as an additional insured any person or additional insureds, the following additional organization for whom you are performing exclusions apply: operations when you and such person or This insurance does not apply to: organization have agreed in writing in a contract or agreement that such person or organization be 1. "Bodily injury", "property damage" or "personal added as an additional insured on your policy. and advertising injury" arising out of the Such person or organization is an additional rendering of, or the failure to render, any insured only with respect to liability for "bodily professional architectural, engineering or injury", "property damage" or "personal and surveying services, including: advertising injury" caused, in whole or in part, by: a. The preparing, approving, or failing to 1. Your acts or omissions; or prepare or approve, maps; shop drawings, 2. The acts or omissions of those acting on your opinions, reports, surveys, field orders, change orders or drawings and behalf; specifications; or in the performance of your ongoing operations for b. Supervisory, inspection, architectural or the additional insured. engineering activities. However, the insurance afforded to such This exclusion applies even if the claims against additional insured: any insured allege negligence or other wrongdoing 1. Only applies to the extent permitted by law; in the supervision, hiring, employment, training or and monitoring of others by that insured, if the 2. Will not be broader than that which you are "occurrence" which caused the "bodily injury" or required by the contract or agreement to "property damage", or the offense which caused provide for such additional insured. the "personal and advertising injury", involved the rendering of or the failure to render any A person's or organization's status as an professional architectural, engineering or additional insured under this endorsement ends surveying services. when your operations for that additional insured are completed. CG 20 33 04 13 © Insurance Services Office, inc., 2012 Page 1 of 2 2. "Bodily injury" or "property damage" occurring C. With respect to the insurance afforded to these after: additional insureds, the following is added to a. All work, including materials, parts or Section III - Limits Of Insurance: equipment furnished in connection with The most we will pay on behalf of the additional such work, on the project (other than insured is the amount of insurance: service, maintenance or repairs) to be 1. Required by the contract or agreement you performed by or on behalf of the additional have entered into with the additional insured; insured(s) at the location of the covered or operations has been completed; or 2. Available under the applicable Limits of b. That portion of "your work" out of which the Insurance shown in the Declarations; injury or damage arises has been put to its intended use by any person or organization whichever is less. other than another contractor or This endorsement shall not increase the subcontractor engaged in performing applicable Limits of Insurance shown in the operations for a principal as a part of the Declarations. same project. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 33 04 13