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HomeMy WebLinkAboutInsurance Certificate: Ausland Builders ATE (MM/DD/YYYY) O PI/28/2016 AC" CERTIFICATE OF LIABILITY INSURANCE 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 Kim Schnetzk NAME: y Ward Insurance Agency PHONE (541) 687-1117 FAX (541)342-8280 (A/C, No, Ext);__ (A/C _N_o);- PO Box 10167 E-MAIL ADDRESS: kim@wardinsurance. net INSURER(S) AFFORDING COVERAGE NAIC # Eugene OR 97440 INSURERA:Continental Western Ins. Co. 804 INSURED INSURER B :AXIS Surplus Insurance Co. Ausland Builders, Inc. INSURERC: DBA: Ausland Group INSURER D: 3935 Highland Avenue INSURER E: Grants Pass OR 97526 INSURER F: COVERAGES CERTIFICATE NUMBER:16/17 GL/AL/UMB/ PROF/ POLL 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 1 ADDLISUBR'. POLICY EFF POLICY EXP LTR TYPE OF INSURANCE I POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS INSD -7xCOMMERCIAL GENERAL LIABILITY Ili EACH OCCURRENCE $ 1,000,000 ~V I OCCUR -DAMAGE TO RENTED 300,000 A PREMISES (Ea occurrence $ X CLAIMS-MADE STOP GAP LIABILITY INCL X Y CPA2967760 2/1/2016 2/1/2017 MED EXP (Any one person) $ 10 , 000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. X PRO- GENERAL AGGREGATE $ 2,000,000 POLICY PRO- LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: - ' AUTOMOBILE LIABILITY l 1 COMBINED SINGLE LIMIT $ 1,000,000 I,~ (Ea accident) XII ANY AUTO BODILY INJURY (Per person) $ A ALL OWNED ! SCHEDULED ( - ) AUTOS AUTOS CPA2967760 2/1/2016 2/1/2017 BODILY INJURY Per accident) X NON OWNED PROPERTY DAMAGE $ III HIRED AUTOS X AUTOS (Per accident) I $ X UMBRELLA LIAB X OCCUR 11 EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DIED RETENTION $ CPA2967760 2/1/2016 2/1/2017 $ WORKERS COMPENSATION PER 0TH- STATUTE ER AND EMPLOYERS' LIABILITY Y/N, 'L EACH ACCIDENT l $ ANY PROPRIETOR/PARTNER/EXECUTIVE N/A ? FFI ER/MEMBER EXCLUDED' L_L DI (Mandatory in NH) E L DISEASE - EA EMPLOYEE I I r- I If yes. DF3CRi desPTiOcribe N under . I OF OPERA I IONS beiow I, $ - POLICY DWI I B PROFESSIONAL LIABILITY I. ELZ779138012016 2/1/2016 1I 2/1/2017 OCCURR - $1,000.000 AGG $2,000,000 B POLLUTION LIABILITY I, ELZ779138012016 2/1/2016 2/1/2017 LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CITY OF ASHLAND, THE ARCHITECT, THEIR EMPLOYEES AND AGENTS ARE NAMED AS ADDITIONAL INSUREDS AS RESPECTS WORK PERFORMED BY NAMED INSURED UNDER WRITTEN CONTRACT AGREEMENT & PER ATTACHED CLCGO013 & CLCG2048. COVERAGE IS PRIMARY & NON-CONTRIBUTORY. WAIVER OF SUBROGATION IS APPLICABLE PER ATTACHED CLCG0013. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF ASHLAND THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 455 SISKIYOU BOULEVARD ACCORDANCE WITH THE POLICY PROVISIONS. ASHLAND, OR 97520 AUTHORIZED REPRESENTATIVE Paul Jensen/TRACFE © 1988-2014 ACORD CORPORATION. All rights reserved. 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