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HomeMy WebLinkAboutInsurance Certificate: Lomakatsi Restoration Project ,aco CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 5/3/2016 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: Kendall Pori Protectors Insurance, LLC PHONE FAX N. No Ext : 41- 42-2 L 963 No):541-772-1906 P.O. Box 4669 E-MAIL Medford OR 97504 ADDRESS:k n II r r in m INSURERS AFFORDING COVERAGE NAIC # INSURER A: AI F r r l n 2411 INSURED LOMAK-1 INSURER B :First National Insurance Co 4724 Lomakatsi Restoration Project INSURER C :American States of Texas PO Box 3084 INSURER D :American States Ins Company 19704 Ashland OR 97520 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 49425024 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY B GENERAL LIABILITY 25CC1600449 4/17/2016 4/17/2017 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $1,000,000 CLAIMS-MADE K OCCUR MED EXP (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 PRO 7 LOC Loggers Broad Form $1,000,000 POLICY F-] JECT C AUTOMOBILE LIABILITY 04CC2285275 4/17/2016 4/17/2017 COMBINED SINGLE LIMIT Ea accident $1,000,000 ANY AUTO BODILY INJURY (Per person) $ ALL OWNED x SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS AUTOS Per accident $ D X UMBRELLA LIAB X OCCUR 01SU43335510 4/17/2016 4/17/2017 EACH OCCURRENCE $2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED X RETENTION $ 10,000 $ A WORKERS COMPENSATION 992153 4/1/2016 4/1/2017 X WC STATU OTH- AND EMPLOYERS' LIABILITY Y / N T RY LIMIT ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Contract for GOODS AND SERVICES As additional insured per policy endorsement CG7635(0207): 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 20 East Main St ACCORDANCE WITH THE POLICY PROVISIONS. Ashland OR 97520 AUTHORIZED REPRESENTATIVE , _ / © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD does not apply to Ttis exdus on apples even 6 the clal ns COMMERCIAL GENERAL LIABILITY {b) Tt s a'Surance - insurance 'bodily tn]ury- or property darn- against any Insured allege nNigence or a CG 7a 35 02 07 age' arising out of the We r sg i- other wrktngdonQ to the supervision, fairing, genes of such person or employment, trahtr!g a rr0-1Vorfng of others orytanaa"chi try that hbured, If the 'occurrence' which caused the 'body Injury` or 'property THIS E14DORSEIAENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. (4) Permits issted by any Slate a political damaga' Irtvoh'ed tna ow,tersf9p, mainta- subdiMsfon with respect to operations nance, usa or ervlntstment to Others of BIT/ LIABILITY PLUS ENDORSEMENT performed by you of on your tehatl, Aircraft, `auto' or watercrag that Is awned subject to the Wlawing adttfo(W pro- or Operated by or rented or bared to arty t71- ve; cured. TTvs e rdorsement modals Insurance pravkled under the f0owrng This trsurarxe does not apply to 't,od%ly Ttds exclusw does not apply to: COW4EACIAL GENERAL LIABILITY COVERAGE PART injury'. 'propy damage"' or (1) A watercraft wht4 ashofe on premises 'personal and advertishg injury' arising you Ov,„ or rent; SCHEDULE out Of cperatlcn,5 performed for the sass Of rn"palty. (2) A watercraft you do not own that Is: TI-,a Insurance with respect to any, arch 'tact, (a) less than 52 Home of Parson or Ofganlzatron_ G feet long; and engineer, u surveyor added as an Insured (b) Not being used to carry persons or by thus endorsement does not apply to property for a charge; BLANKET - PER CERTIFICATE OF INSURANCE canal Iy and d Ad rproP~Y dernags', or per- 3) P 'auto' on, or on the ways [ the inj fa luryur'e a to rc raringx#er out Air/ y ( nexi ~ p &I remmises you o%n or rent, pro- ha rendernft g of of or th v,Ided the latto• is not Owned by or professionaf services by or for you. inctud rented or banal to you a the insured; Pig ving, or faTn to (4) Uah7 y assumed under a ty l insured {t} The preparlng, appro 9 con tact' for the aAnet5hlp, malnte- prepare or approve reaps, draMngs, nar" Or use of alrcra't of rratefcra't; or opinions, reports, surveys. change or- defs, designs or spa-CfCaatiorts; and (5) '00dly to uty' or 'property damage' ADDITIONAL INSURED BY WRITTEN lease or occupy, sut'efct to the favMng arlsir-ig out or: CONTRACT, AGREEMENT OR PERMfT, OR ad Oonafprovrslons. (2) Supervisory, laspelbon or eng'n(!er'mg services. (a) the operaton of machinery or SCHEDULE (a} Thus Insurance does not apply to equpment that Is Attached to, or any bccurrenco' wf,Ich takes place d. The insurance does not apply to 'bodily pars of, a tand vehicle that weu'd The fo8aNtng paragraph Is added to Wxo IS AN after you ceaso to to a tenant h Injury' or 'proper-.y damage' 1nctuded within quar;;fy under the dclx"n of INSURED (Section II): spry prom?ses leased to or rented to the 'products-corrpie'-ed opera!ons haz- •mobi€e equipment` If h Y ere not 4. ArV person or organlza!on sho mi In the Schell SAS erd'- sued to a compulsory or financial Ufa trla of for wtAm yor are ift to pr by e vail!en h-is Dort (b) Th?s Insurance does not apply to responsblrry tan or other motor ve- A person's of organlza~ori s s+atus in an Insured un- flcle insurance law In tie state tract, eg eamEnt or pemvt to provide frzswance any Ahxtural Akerations, now con- der bras endorsement ends when your operations for where R Is licensed or pr r c pally Is an Insured, subject to the following aMtional sfrucbon Or derr4t'on Op®ratoo s provWcns perforated by or on behalf of the that Insured are compre'c-d. Garaged.' or a. The contract, agreement or permit must be person Of wganaation added as an (b) ft operation or arr/ of the machLn- fn effect during the ti cy period shown In Insured; Na omre age wr:1 be provided if, In the absence of this cry, or equ prrent Isted In Paragraph po endorsement, no biabT-y would be Impo<_ed by law on f.(2) of f.(3) of the 6 nation of the Oecfa a ens a^d must have been exE• (2) Your mgo`ng operations for that In- you_ Coverage sh.0 be fruited to the e;dent of your 'mobile equipmert'. cured prior to the 'bodily InJtuy', poperty sured, whether the meK 6 performed negligence or fautt according to the eppl'cah!a phncl- damage", or 'personal and advertisirg by You or for YO1-4 ples of cornpara ive fault (6) An aircraft you do not own pravldsd It Is InImm. (3) The ma'ntenance, operation or use by net operated by arty Insured. b. Tha parson or otganlsati n added as an in- you of equipment leased to you by such NON-OWNED WATERCRAFT AND NON-OWNED TENANTS' PROPERTY DAMAGE LIABILITY cured by this endorsement is an hstrred only person or organhatiof% subject to the AIRCRAFT LIABILITY to the extent you Ara held Uabta due to: f0oMng addltfonal provisions' When a Damage To Premises Rented To You Ltmlt Is (t) The ownership, rra~ln!enance a use of (a) This Insurance does riot ep* to Exdusion g. of COVERAGE A (Sec' 'On 1) Is replaced shown In the Declarations, Exclusion j. of Cure-raga that part of premises you awn, rent, Any 'ocxurrenoo' wtlch to<es place by lira fofowing: A, Section 1 Is rep'aced by the fOlO'hfng: after the agcrpmeN lease e0es; U. 'godly fn; ay' or `property damage' erasing out of the ownerhlp, maintenance, use of j• Damage To Property en:'rustmenl to others of any a'r faft, 'auto. 'Property damage' to: or watercra`t Ovmed Of operated by or rented Indudes Copyrighted Material of Insurance Ser tes OffikB, Va. wish Its perrrlsslon or loaned to airy Insured. Use Indude5 open- {1) Property you own, rent or occupy, Enc3ud g Cepyfi,ght, Insurance SMICas, 2001 anon and -loading Or unloading'. Any costa Or expenses Incurred by you, of 5+`~n rt r. 3c'eca Ao s: r<;a-cT3 rdrau d st+o Co~uc:r 63 76 35 N V Pave f a k P;c Z fd i CG7635(0267) pdf CG7635(0207) pdf any other person, aganizaton or entity, for WHO IS AN INSURED MANAGERS EXTENDED DEFINITION OF BODILY INJURY Interrupted only by a street, roadxay, waterway, or repair, replacement, enhancement, restofa• right-of-way of a railroad. Lion of malruenance of such property for arry The fO1 uMng Is added to Paragraph 2.e, of WHO IS Paragraph 3, of DEFL,TTTOAIS (Section V) Is replaced reason, Inckxr.) preyeriffon of hjury to a AN INSURED (Section 11): by the folloMrq, INCREASED MEDICAL EXPENSE LIMIT person a damage to anther's pxoperty; (2) PrarNsas You sell, 9N'e away or ebabandon, B Paragraph (1) does not apply to exect&a 0ifixrs, a 3. "Wly iryytuy" rreans bodly Injury, s1CKness a The Mescal Expense Umg is Amended to $10,000. disease susta'ned by the 'property damage' Arises out of any part to managers at the supeMsory level or above, arxJu~h o or r death res a person, Including mental uf'~ng from any of these at [{NOWLEOGE OF OCCURRENCE of those premises' SUPPLEMENTARY PAYMENTS - COVERAGES A any time. (3) Property loaned to you, AND 8 - BAIL BONDS - TIME OFF FROM The fo0aving Is added to Paragraph 2. Dines In The Wbdy or WORK TRANSFER OF RIGHTS OF RECOVERY Evwt of Occurrence. Offense, Claim Of Suit of (d) oo Pef sonrsrnal of properly roperty Insured; t}s care, cCOt6WERCIAL GENERAL UMLITY C(kiDF=AS Paragraph 1,b, of SUPPLEMENTARY PAYMENTS - The fvtowing Is added to Paragraph S. Transfer Cf (Section IV): (5) That partict9ar part of teat property on which COVERAGES A AN'D B Is replaced by the fO4c,&ing• Rights Of Recovery Agalnst Others To Us of CO~t- you or airy contractors a subcont acrors MERCIAL GENERAL UA13LITY =XITICNS (Sec' Krawtedga of an 'occurrence', dem or 'suit' by woekhg directly or M,rect.'y on your behalf b, Up to 63,000 for cost of bail bonds required ton IV): your agent, servant Or emptoyee shall not in fise:'f are performing operations, if tta 'property because of ecckfen's or lraf n law viola -ons cOnstime knoANadga of the named insured unless an damage' arises cut of thoss op_ra!;ons, or arlshng out of the use of any vehicle to which We waiva arr/ righs of recovery we may ha',+e Wn5t officer of the named insured has received such notice the raspy Wtey LUTIty Coverage spprr s. any person or organota9an because of payments we from the agent, servant Or empfoyea. (6) That panccufar part of airy property that m.r7t We do not have to fvrntsh these bonds. make for Injury or damage Arising out of your oogotng ba restored, repaired or replaced because operation3 Or your work' done under a contract with UNINTENTIONAL FAILURE TO DISCLOSE ALL your worn' was Incorrectly performed on it. Paragraph t.d- of SUPPLEVE14TARY PAYMENTS - that person a organlzabon and Ir4kvkd In the HAZARDS Paragraphs (1), (3) and (4) of this exclusion do COVERAGES A A>4D B Is replaced by the folkrr+Ing: 'productsoorrpte!ad operations hazard. This wa3 rer not apply to 'roperty damage" (other than d- As reasonab'.e expenses Inclxred by the Irr appt~s only to a person or agargzaton for wfom you The fotlah{ng is added to Paragraph b- Rcpresen}a- darnage by fire) to premises, rncluc5ng the tort- cured at out request to assist us In the In- are regLued by wrttsn contract, agreement or permit lions of =%t ERGIAL GEfrERAL U,%NUTY CONDI. tents of such premise;, rented to you. A separate vestigaton of defense of &.a claim or 'suit', to v4va these rights of recarery. MIN'S (Section IV): Iffnrt of Insurance eW.,es to Damage To Pfem- h dudhg Actual loss of earnings up to 5500 Ises Rented To You as desc;Zed h SectSon M a day because of time Of from wore. AGGREGATE LIMITS OF INSURANCE - PER Il you urlnten5ona!ly fall to dsclose any hazards ex- - Urnits Of Insurance. LOCATION tjtktg at the h c&gon data of youu palsy, V,a wail not Paragraph (2) of thfs exdustat does not apply It EMPLOYEES AS INSUREDS - HEALTH CARE such !acOverage =ura. Hon et-, rihso pra.'ge Form oes not se 01 'i- the remses are "ek' and were never SERVICES For all surrs Y,hlch the insured becomes lega:°/ bb s p gated to pay a3 damages caused by `occunencos" our right to collect aWtionaf premium or extrc~e our Effect ocupied. [en °d or he d for rental by you. mod'ca] Prov6i0r1 2.a_(1}{d} of WHO 1S AN INSURED (Section under COVERAGE A (Section I), and for e0 right of cancetfation or non-renzw23, Paragraphs (3), (4), (5) And! (6) of V'k excfuslon B) Is deleted, tinless excluded by separate Lodorse- expenses caused by accidents udder COVERAGE C do not apply to fiabllry assumed under a side- merit (Section y, rttlch can be attrfiU:ed only to Opera'ons LIBERAL17ATiON CLAUSE track Agreement at a single location': Paragraph (6) of this exclusion does not apply to EXTENDED COVERAGE FOR NEWLY ACQUIRED The foltowRng paragraph Is added to WNNERGAL your 'nsuranoCceaSons- (Sec GENERAL LtAaUTY CONDITIONS (Secton IV): property damage' Inofuded In tra 'products- ORGANIZATIONS bParonagraphs 2,a. and 2.b. of eLl,-rits of ach h of f Insurance uzr7tpte'ed operations hazard'. 6i} apps/ sapara;ely to e Proylsfon 3,a. of apace IS AN INSURED (Section If) Is owned by or rented to }fair. 10. If a rev,tsTon to thlS Coverage Part Atkh would by the toJow prar'da more co'rerage with no aMKonat pre- Paragraph 6, of LIMTS OF INSURACE (Section 11 1) replaced NI 'Loceon' means premises hvblvrng the same of r ium, tecorries effective during thepoIxy period Is replaced by the fo!toWng a. Coverage under this proavision is Afforded cooneodng lots, or premises whose connea0n Is in tho sate shown In b-a Declarabcns, your pO1- 6. Sutyect to b. above, the Damage To Promisss only unn the end of the porgy period. icy wel automa9calPy, provide tlls addihoral cev- Ren',ed To YOU Lauri; Is the most we will pay urn efaga on the effect)ya date of the rw.tlon. der Cevarage A for damages because Of EXTENDED `PROPERTY DAMAGE' 'property damage' to any one premises. wtaile Exclusion a. of WIERAGE A (Section I) Is solaced rented to yrou, a in the case of damage by fire, by the totlvwing: wldle rented to you or temporanly oocupled b/ you with permission of the mutter. a. 'Bodily Injury' or 'property damage' expected or Interdod TTe Damage To Premises Rented TO You Irnit Is tha This s axchslon from lees the standpoint net Ap applly y t to of 'belthely Injury- higher of the Each Occurrence Umit shown In tfA or property damage' fasulting from the use of Declarations or the amount shown In the Declarations reasonab a fats to protect persons of property. as Damage To Premisas Rented To Yoru Llrrk 0o 76 35 M 97 P .i 3 ci k iT FKi 4 1$ 4 CG7635(0207).pdf CG7635(020T) pdf