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HomeMy WebLinkAboutInsurance Certificate: JAM Construction 9JAMCON OP ID: KD 2016Y) CERTIFICATE OF LIABILITY INSURANCE 0 D5125/ /2016 ~ 05/25 THI CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CEK rIFICATE 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). CONTACT AME: PRODUCER Phone: 541-779-4232 N Hart Insurance Fax: 541-772-3963 PHONE FAX 1123 Royal Ave. A/c No Ext : A/C, No : Medford, OR 97504 E-MAIL ADDRESS: Hart Insurance / Medford INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Cincinnati Specialty 10677 INSURED JAM Construction Inc INSURER B : SAIF Corp 682 Mountain View Drive Medford, OR 97504 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. I R TYPE OF INSURANCE ADDL SUB POLICY NUMBER MM LT R / D//YYYY MM DDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X CS00038810 05/01/2016 05/01/2017 DAMAGE PREMISES S ( Ea RENTED occurrence $ 100,00 CLAIMS-MADE 41 OCCUR MED EXP (Any one person) $ excluded PERSONAL &ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,00 F] 11 F] PRO LOC $ X POLICY AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED P O RTY DAMAGE $ HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS' LIABILITY TORY LIMITS ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N 974161 05/01/2016 05/01/2017 E.L. EACH ACCIDENT $ 500,00 OFFICER/MEMBER EXCLUDED? F N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 500,00 If yes, describe under 500,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) certificate holder is listed as additional insured per form CSGA4035 CERTIFICATE HOLDER CANCELLATION CITYASH 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. Public Works Dept. 20 E. Main Street AUTHORIZED REPRESENTATIVE Ashland, OR 97520 Hart Insurance / Medford ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: CSU0038810 COMMERCIAL GENERAL LIABILITY CSGA 4035 06 12 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - YOUR OPERATIONS (LIMITED) This endorsement modifies insurance provided under the following: COMMERICAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or Organization(s): City of Ashland A. SECTION II - WHO IS AN INSURED is The limits applicable to the additional insured amended to include as an additional insured are those specified in any written contract or the person(s) or organization(s) shown in the agreement or in the Declarations of this Cov- Schedule, but only to the extent that the liabil- erage Part, whichever is less. If no limits are ity for "bodily injury, "property damage" or specified in a written contract or agreement, "personal and advertising injury" is caused the limits applicable to the additional insured only by your negligent acts, errors or omis- are those specified in the Declarations of this sions in the performance of ongoing opera- Coverage Part. The limits of insurance are in- tions for additional insured shown in the sche- clusive of and not in addition to the limits of in- dule. surance shown in the Declarations. B. With respect to the insurance afforded to D. With respect to the insurance afforded to these additional insureds, the following addi- these additional insureds, SECTION IV - tional exclusions apply: COMMERCIAL GENERAL LIABILITY CON- DITIONS, 4. Other Insurance is amended to This insurance does not apply to: include: 1. "Bodily injury", "property damage" or "per- Any coverage provided herein will be excess sonal and advertising injury' to any em- over any other valid and collectible insurance ployee of you or to any obligation of the available to the additional insured whether pri- additional insured to indemnity another mary, excess, contingent or on any other basis because of damages arising out of such unless you have agreed in a written contract or injury. written agreement executed prior to any loss that this insurance will be primary. This insur- 2. Bodily injury , property damage or per- sonal and advertising injury' for which the ance will be noncontributory only if you have Named Insured is afforded no coverage so agreed in a written contract or written under this policy of insurance. agreement executed prior to any loss and this coverage is determined to be primary. C. With respect to the insurance afforded to these additional insureds, SECTION III - LIM- ITS OF INSURANCE is amended to include: Includes copyrighted material of Insurance CSGA 4035 06 12 Services Office, Inc., with its permission. Page 1 of 1