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Home My WebLink AboutInsurance Certificate: Gage It Construction LLC GAGE01 C OP ID: EKC ,acoRa► CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 03/02/2016 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: Cindy Sorensen United Risk Solutions, Inc. PHONE 541-245-1111 FAX PO Box 936 ac No E:t): (A/c, No): 541-245-1112 Medford, OR 97501-0067 aE,DMO ess: cindy.sorensen@unitedrisk.com Jim R. Cox INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Western National Assurance Co 124465 INSURED Gage It Construction LLC INSURER B : SAIF Corporation 136196 P.O. Box 3483 Central Point, OR 97502-0018 INSURER c : INSURER D 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 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 TYPE OF INSURANCE INSR SUER LTR i POLICY NUMBER MM DD/YYYY MM/ D/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMA E T RENTED A X COMMERCIAL GENERAL LIABILITY X CPP103830005 03/09/2016 03/09/2017 PREMISES (Ea occurrence) $ 300,000 I~ ~ CLAIMS-MADE X OCCUR MEN (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 POLICY 7X:] PRO- n LOC $ - - JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 accident) (Ea $ CPP103829905 03/09/2016 03/09/2017 BODILY INJURY A ANY AUTO ! BODILY (Per person) $ X ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X HIRED AUTOS X~ NON-OWNED PROPERTY DAMAGE $ AUTOS (PER ACCIDENT) X UMBRELLA LIAB X OCCUR I EACH OCCURRENCE I $ 1,000,000 A EXCESS LIAB CLAIMS-MADEI UMB100639008 03/09/2016 03/0912017 AGGREGATE $ 1,000,00 DED X RETENTION $ 10,0001 $ WORKERS COMPENSATION WCSTATU- X IOTH-i AND EMPLOYERS' LIABILITY Y / N B ANY PROPRIETOR/PARTNER/EXECUTIVE 756250 05/01/2015 05/0112016 E .L TORY LIMITI-_i-_ER OFFICER/MEMBER EXCLUDED F-1 I N/A EACH ACCIDENT $ 1,000,00 (Mandatory in NH) '_E L. DISEASE - EA EMPLOYEE $ 1,000,00 It yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,00 I I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Ashland and its officers, employees and agents whlie acting within the scope of their duties as such are Additional Insured as provided by Endt. WNGL52 01/09. CERTIFICATE HOLDER CANCELLATION CITAS03 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 E. Main St. Ashland, OR 97520-1814 AUTHORIZED REPRESENTATIVE &&A Gth* ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY WN GL 52 01 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OREGON ADDITIONAL INSURED - OWNERS, d LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU PRIMARY AND NONCONTRIBUTORY & This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II - Who Is An Insured is amended to in- a. The preparing, approving, or failing to pre- clude as an additional insured any person or organ- pare or approve, maps, shop drawings, opin- ization for whom you are performing operations ions, reports, surveys, field orders, change when you and such person or organization have orders or drawings and specifications; or agreed in writing in a contract or agreement that b. Supervisory, inspection, architectural or en- such person or organization be added as an addi- gineering activities. tional insured on your policy. Such person or organ- ization is an additional insured only with respect to 2. "Bodily injury" or "property damage" occurring liability for "bodily injury", "property damage" or after: "personal and advertising injury" caused by your a. All work, including materials, parts or equip- ongoing operations for the additional insured and only to the extent that such "bodily injury", "property ment furnished in connection with such damage" or "personal and advertising injury" is work, on the project (other than service, caused by your negligence or the negligence of maintenance or repairs) to be performed by those performing operations on your behalf. or on behalf of the additional insured(s) at the location of the covered operations has M A person's or organization's status as an additional been completed; or N insured under this endorsement ends when your b. That portion of "your work" out of which the operations for that additional insured are com- pleted. injury or damage arises has been put to its intended use by any person or organization B. The Limits of Insurance applicable to the additional other than another contractor or subcontrac- insured are those specified in the written contract for engaged in performing operations for a or written agreement or in the Declarations of this principal as a part of the same project. policy, whichever is less. These Limits of Insur- ance are inclusive of, and not in addition to Limits D. As respects the coverage provided under this en- of Insurance shown in the Declarations. dorsement, Paragraph 4.b. of the Other Insurance C Condition is deleted and replaced by the following: C. With respect to the insurance afforded to these ad- 4. Other Insurance ditional insureds, the following additional exclusions apply: b. Excess Insurance This insurance does not apply to: This insurance is excess over any other in- 1. "Bodily injury", "property damage" or "personal surance naming the additional insured as an and advertising injury" arising out of the render- insured whether primary, excess, contingent ing of, or the failure to render, any professional or on any other basis unless the written con- architectural, engineering or surveying services, tract or agreement described in A. above including: specifically requires that this insurance be provided on either a primary basis or a pri- mary and noncontributory basis. WN GL 52 01 09 Includes copyrighted material of Insurance Services office Inc. with its permission Page 1 of 1