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HomeMy WebLinkAboutInsurance Certificate: Copeland Construction (2) ® DATE (MM/DD/YYYY) Ai*COR" CERTIFICATE OF LIABILITY INSURANCE 6/1/2016 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: Jessica Embree Zarosinski-Leavitt Insurance Agency of Oregon A/ONN Ext. (503) 639-4220 AAA No: (503)639-4449 Leavitt Group of Portland ADDRESS:jessica-embree@leavitt.com 8285 SW Nimbus Ave, Ste 120 INSURER(S) AFFORDING COVERAGE NAIC # Beaverton OR 97008 INSURERA:American Hallmark Ins Co of TX 43494 INSURED INSURER B :SAIF 036196 Copeland Construction LLC INSURER C : 321 Pruett Rd. INSURER D : INSURER E : Eagle Point OR 97 524 INSURER F : COVEPAOES CERTIFICATE NUMBER:16/ 17 pckg 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 MMIDD/YYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 ~ DAMAGE TO RENTED 100,000 A CLAIMS-MADE ° OCCUR PREMISES Ea occurrence $ 44CL464731-06 6/3/2016 6/3/2017 MED EXP (Any one person) $ 5, 000 PERSONAL & ADV INJURY $ 1, 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO LOC 2,000,000 JECT PRODUCTS - COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 11000,000 (Ea accident) I A X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED n 44CL464731-06 6/3/2016 6/3/2017 BODILY INJURY (Per accident) i $ 1 AUTOS NAUTOS ON--OWNED I PROPERTY DAMAGE Per accident $ HIRED AUTOS AUTOS ~ $ PIP-Basic X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 11000, 000 A EXCESS LIAB 1 CLAIMS-MADE AGGREGATE _ 11 000,000 IDED X RETENTION$ 10,000 44CU476415-04 6/3/2016 6/3/2017 1$ WORKERS COMPENSATION X I PER OTH- AND EMPLOYERS' LIABILITY Y / N STATUTE i ER ANY PROPRIETOR/PARTNER/EXECUTIVE ~_El EACH ACCIDENT $ 5001000 B (Manila in OFFICER/MEMBER EXCLUDED? N ;(Mandatory (Mandatory NH) 980838 1/1/2016 1/1/2017 E.L. DISEASE - EA EMPLOYEE $ 500, 000 I If yes, describe under - - - - - - - - DESCRIPTION OF OPERATIONS below E.L. DISEASE --POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 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 90 N Mountain ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE J Embree, Exec/JDE `'LJ ~1CC~C~ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (201401)