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HomeMy WebLinkAboutInsurance Certificate: Kogap Enterprises ® F DATE (MM/DD/YYYY) o CERTIFICATE OF LIABILITY INSURANCE 3/29/2016 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 have ADDITIONAL INSURED provisions or 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). CONTACT AME, Susan Wilson PRODUCER Brown & Brown Northwest N 3256 Hillcrest Park Drive PHONE Ext: 541-494-2658 aFAX, /c No: 541-494-2758 Medford, OR 97504 E-MAIL ADDRESS: swilson bbnw.com INSURER(S) AFFORDING COVERAGE NAIC # www.bbnw.com INSURER A : American States Insurance Company 19704 INSURED INSURER B : General Insurance Company of America Kogap Enterprises, Inc. INSURERC: Travelers Casualty and Sure Co America 31194 PO Box 1608 Medford OR 97501 INSURER D : Westchester Fire Insurance Company 10030 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 29203172 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMIDDlYYYY MMIDD/YYYY A COMMERCIAL GENERAL LIABILITY ✓ 01C168337241 4/1/2016 4/1/2017 EACH OCCURRENCE $ 1,000,000 DAMAGE CLAIMS-MADE [ OCCUR P R E M SESOEa occur Drence $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ❑ JECT PRO [V] LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY 24CC31464911 4/1/2016 4/1/2017 COMBINED SINGLE LIMIT $ Ea accident 1,000,000 ✓ ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UM/UIM Liabilit $ 1,000,000 A ✓ UMBRELLA LIAB OCCUR 01SU4271522 4/1/2016 4/1/2017 EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED ✓ RETENTION $10,000 $ WORKERS COMPENSATION PER OTH- Y!N STATUTE ER AND EMPLOYERS' LIABILITY ANYPROPRiETOR/PARTNER/EXECUTIVE ❑ E.L. EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ C BOLI Bond (Statutory) 104657918 1/1/2016 1/1/2017 Limit: $30,000 D Employment Practices Liability G27433121002 4/1/2016 4/1/2017 Limit: $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Sediment Removal at East and West Forks of Ash and Creek. General liability Policy includes Blanket Adaitional Insured coverage as required by written contract per endorsement CG86741207 (attached). Subject to policy terms, conditions and exclusions. CERTIFICATE HOLDER CANCELLATION City of Ashland, its agents, officers & SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN employees. ACCORDANCE WITH THE POLICY PROVISIONS. 20 E Main St Ashland OR 97520 AUTHORIZED REPRESENTATIVE Susan Wilson ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 86 74 12 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS LIABILITY PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any person or organization for whom you are required by written contract, agreement or permit to provide additional insured endorsement. DUTY TO DEFEND or B or medical expenses under COV- ERAGE C. Paragraph a. of SECTION I - COVERAGE A and No other obligation or liability to pay sums or COVERAGE B is replaced by the following: perform acts or services is covered unless ex- a. We will pay those sums that the insured be- plicitly provided for under SUPPLEMENTARY comes legally obligated to pay as damages PAYMENTS - COVERAGES A AND B. because of "bodily injury", "property damage" or "personal injury and advertising EMPLOYERS LIABILITY injury" to which this insurance applies. We will have the right and duty to defend the in- The last paragraph of exclusion e. of SECTION I - sured against any "suit" seeking those dam- COVERAGE A is replaced by the following: ages. Our duty to defend begins once you This exclusion does not apply to liability assumed notify us of a "suit" as described in SEC- TION IV -COMMERCIAL GENERAL LI- by the insured under an "insured contract" ex- ABILITY CONDITIONS, 2.b. However, we cept for that part of a contract or agreement that will have no duty to defend the insured indemnifies any person or organization for their against any "suit" seeking damages for sole liability. "bodily injury", "property damage", or "personal injury or advertising injury" to WRONGFUL EVICTION which this insurance does not apply. We The following exclusion is added to SECTION I ray, a* ol_ w dss,ret;or, `,-ves*'ga_e &ry "occurrence" and settle any claim or "suit" COVERAGE B: that may result. But: The wrongful eviction from, wrongful entry into, (1) The amount we will pay for damages is or invasion of the right of private occupancy of a limited as described in SECTION III - room, dwelling or premises arising out of any: LIMITS OF INSURANCE; and (1) "property damage" to the room, dwell- (2) Our right and duty to defend ends when ing or premises; or we have used up the applicable limit of (2) "bodily injury" sustained through occu- insurance in the payment of judgments pancy of a room, dwelling or premises. or settlements under COVERAGES A CG 86 74 12 07 ADDITIONAL INSURED - BY WRITTEN CON- This insurance does not apply to "bodily TRACT, AGREEMENT OR PERMIT, OR SCHED- injury", "property damage", or ULE "personal and advertising injury" arising out of operations performed for the state The following paragraph is added to SECTION 11 - or municipality; WHO IS AN INSURED: c. The insurance with respect to any architect, 4. Any person or organization shown in the Sched- engineer, or surveyor added as an insured ule or for whom you are required by written con- by this endorsement does not apply to tract, agreement or permit to provide insurance "bodily injury", "property damage", or is an insured, subject to the following additional "personal and advertising injury" arising out provisions: of the rendering of or the failure to render any professional services by or for you, in- a. The contract, agreement or permit must be cluding: in effect during the policy period shown in the Declarations, and must have been exe- (1) The preparing, approving, or failing to cuted prior to the 4-lily injury", "property prepare or approve maps, drawings, damage'", or "PE al and advertising Opinions, reports, surveys, change or- injury". ders, designs or specifications; and b. The person or organization added as an in- (2) Supervisory, inspection or engineering sured by this endorsement is an insured only services. to the extent you are held liable due to: d. This insurance does not apply to "bodily (1) The ownership, maintenance or use of injury" or "property damage" included within that part of premises you own, rent, the "products-completed operations lease or occupy, subject to the following hazard". additional provisions: e. A person's or organization's status as an in- (a) This insurance does not apply to sured under this endorsement ends when any "occurrence" which takes place your operations for that insured are com- after you cease to be a tenant in pleted. any premises leased to or rented to f. No coverage will be provided if, in the ab- you; sence of this endorsement, no liability would (b) This insurance does not apply to be imposed by law on you. Coverage shall any structural alterations, new con- be limited to the extent of your negligence struction or demolition operations or fault according to the applicable principles performed by or on behalf of the of comparative fault. person or organization added as an g. The defense of any claim or "suit" must be insured; tendered as soon as practicable to all other (2) Your ongoing operations for that in- insurers which potentially provide insurance sured, whether the work is performed for such claim or "suit". by you or for you; h. The insurance provided will not exceed the (3) The maintenance, operation or use by lesser of: you of equipment leased to you by such (1) The coverage and/or limits of this policy, person or organization, subject to the or following additional provisions: (2) The coverage and/or limits required by fa) "~~s ;^s !raise does apply to sa,d co:5z ac , agreemenl or permit. any "occurrence" which takes place after the equipment lease expires; NON-OWNED WATERCRAFT AND NON-OWNED (b) This insurance does not apply to AIRCRAFT LIABILITY "bodily injury" or "property damage" arising out of the sole Exclusion g. of SECTION I - COVERAGE A is re- negligence of such person or or- placed by the following: ganization; g. "Bodily injury" or "property damage" arising (4) Permits issued by any state or political out of the ownership, maintenance, use or subdivision with respect to operations entrustment to others of any aircraft, "auto" performed by you or on your behalf, or watercraft owned or operated by or rented subject to the following additional pro- vision: