HomeMy WebLinkAboutInsurance Certificate: OBEC Consulting Engineers (3)
Client#: 331197 OBECCONE
[DATE (MWDD/YYYY)
ACORDTM CERTIFICATE OF LIABILITY INSURANCE 9/25/2015
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 CONTACT
NAME:
Kibble & Prentice, a USI Co PR PHONE 206 441-6300 FAX -362-8528
(A/C No Ext): No): 610 _
601 Union Street, Suite 1000 A IIess: pl.certrequest@usi.biz
Seattle, WA 98101
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A : XL Specialty Insurance Company 37885
INSURED INSURER
OBEC Consulting Engineers' Inc. _ B
INSURER C _
920 Country Club Rd, #100B
NSURER
Eugene, OR 97401
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 CONTRACTOR 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 LIMITS
LTR TYPE -0-F LINSURANCE INSR.:WVD_ POLICY NUMBER . _ (MM/DD/YYYY) (MMIDD/YYYY LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE I
-PREMISES ~S
_ CLAIMS-MADE 'OCCUR DAMAGE RENTED , ~_PREMSESS (Ea occurrence) S
MED EXP (Any one person)
PERSONAL & ADV INJURY S
GEN'L AGGREGATE LIMIT APPLIES PER: I-
GENERAL AGGREGATE $
PRO- A---
POLICY LOC PRODUCTS - COMP/OP AGG
OTHER:
AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT
fEa accident) S
~ ANY AUTO i SCHEDULED BODILY INJURY (Per person) $
ALL OWNED
AUTOS AUTOS BODILY INJURY (Per accident) S
NON-OWNED PROPERTY Y - DAMAGE - - I
_
AUTOS AUTOS AUTOS (Per acciden-1_ Is
CCUR
UMBRELLA LIAB ITCLAIMS-MADEACH OCCURRENCE $
- EXCESS LIAB
AGGREGATE
LED RETENTION $ $ -
WORKERS COMPENSATION ' PER 7OTD-1-_
AND EMPLOYERS' LIABILITY Y / N STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER m (Mandatory NHEXCLUDED. N / A E.L. EACH ACCIDENT S
E.L. DISEASE EA EMPLOYEE S
If es describe under
DESCRIPTION OF OPERATIONS below EEL: DISEASE POLICY LIMIT
A Professional DPR9725532 9/25/2015 09/25/2016 $5,000,000 per claim
Liability $5,000,000 annl aggr.
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Re: Contract for Personal Services - Calle Guanajuato Resurfacing Project.
CERTIFICATE HOLDER CANCELLATION
City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Attn: Kari Olson ACCORDANCE WITH THE POLICY PROVISIONS.
90 N. Mountain Avenue
Ashland, OR 97520 AUTHORIZED REPRESENTATIVE
@ 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S16280819/M16280482 MDKZP
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KIBBLE L PRENTICE A USI COMPANY
CERTIFICATE RETURN MAIL PROCESSING
P.v. BOX 5007
NOVATO, CA 94948-5007
CITY OF ASHLAND
ATTN: KARI OLSON
90 N MOUNTAIN AVE
ASHLAND OR 97520-2014