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HomeMy WebLinkAboutInsurance Certificate: Miller Consulting Engineers (2) 1 AlCO'R" CERTIFICATE OF LIABILITY INSURANCE DATE{MM/DD/YYYY) 09/29/2016 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 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: Marsh Sponsored Programs PHONE 800-338-1391 FAX a division of Marsh USA Inc. A/C No Ext: A/C, No:888-621-3173 E-MAIL PO Box 14404 ADDRESS: acecclientrequest@marsh.com Des Moines IA 50306 INSURER(S) AFFORDING COVERAGE NAIC# INSURERA:Hartford Accident & Indemnity Co 22357 INSURED INSURERB:Twin City Fire Insurance Co 29459 Miller Consulting Engineers INSURER C : 9570 SW Barbur Blvd Ste. 100 Portland, OR 97219 INSURER D: INSURER E : L 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 ADDL SUBR LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDDIYYY MMIDD/YYYY LIMITS A GENERAL LIABILITY y 84SBWCG3000 11/01/2016 11/01/2017 EACHOCCURRENCE $1,000,000 - X COMMERCIAL GENERAL LIABILITY Prof . Liab . Excl . PREMI ES ( RENTED ~ SES Ea occurrence $1, 000, 000 CLAIMS-MADE F x I PREMI OCCUR MED EXP (Any one person) $10,000 PERSONAL &ADV INJURY $1, 0001 000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 POLICY PRO- [ LOC $ A AUTOMOBILE LIABILITY y 84SBWCG3000 11/01/2016 11/01/2017 COMBINED SINGLE LIMIT Ea accident $1,000,000 ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X IX NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ A X UMBRELLA LIAB X OCCUR 84SBWCG3000 11/01/2016 11/01/2017 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE s5,000,000 - - - - DED X RETENTION $ 10, 0 0 0 $ B WORKERS COMPENSATION 84WBGBM4093 11/01/2016 11/01/2017 WCSTATU- OTH- AND EMPLOYERS' LIABILITY YIN X TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED? ❑ NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1, 000 , 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) re: Seismic re-evaluatin of the Ashland City Hall The City of Ashland, Oregon, and its elected officials, officers and employees are named as additional insured on the above referenced policies when required by written contract. 30 day notice of cancellation will be given to cert holder when required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland AUTHORIZED REPRESENTATIVE 20 East Main Street Ashland, OR 97520 © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD