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HomeMy WebLinkAboutInsurance Certificate: Lawco Fire Protection E~=rom INSURANCE MARKETPLACE 03/08/2017 08:41 #249 P.001/OOS LAWCO-1 OP ID: DR % A~0 DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 03/08/2017 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 Phone: 541-779-0177 NAME CT Insurance Marketplace, Inc. Fax: FAX 772-8235 PHONE - ext): I IArC, Not: 1998 Sky park E park Dr Suite 100 IA Medford, OR 97504 E-MAIL ADDRESS: James A Hatton INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Saif Corporation INSURED Lawco Fire Protection LLC w INSURER B : Rockhill Insurance Company Shawn Cox 5350 Bounty Ln ENSURER C : Central Point, OR 97502 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. INSR ADDL' UBR; POLICY EFF POLICY EXP LIMITS JJB TYPE OF INSURANCE INSR WVD I POLICY NUMBER MM/DD/YYYY MMIDD/YYYV 1 GENERAL LIABILITY EACHOCCURRENCE $ 1,000,00 B X J COMMERCIAL GENERAL LIABILITY X RFSCAK000154-00 02/12/2017 02/12/2018 PDAMA E TO RENTED REMISES (Ea axu ence'. ; $ 100,00 - ~y~ _ I X OCCUR i I MED EXP fAny one person) $ +00 I CLAIMS-MADE 5 1 PERSONAL s ACV INJURY & 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMP/OP AGG I $ 2,000,00 POLICY X PRO LOC $ I AUTOMOBILE LIABILITY COa MBINEDISINGLE LIMIT $ _ ANY AUTO BODILY INJURY (Per Person) $ ALL OWNEn SCHEDULED - AUTOS € AUTOS BODILY INJURY (Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS JPeraccident> X UMBRELLA LIAB X f OCCUR i EACH OCCURRENCE $ 1,000,00 B EXCESS LIAB _ M CLAIMS-MADE RFSXAK000077-00 02/12/2017 02/1212018 AGGREGATE $ 1,000,00 DED X : RETENTION 10000 $ WORKERS COMPENSATION I WC STATU OT H- IMIT AND EMPLOYERS' LIABILITY 1 LTD KY-1 A ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N 762328AR 07/01/2016 07101/2017 E.L. EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? ❑ N I A (Mandatory in NH) E.L. DISEASE- EA EMPLOYEE $ _ 1,000,00 If es, describe under DESCRIPTION OF OPERATIONS below ! EL DISFASF - POLICY LIMIT ? S 1,000,00 4 3 I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) City of Ashland as additional insured forma CG2010 0704, CG2001 0413 & CG2037 0704 attached CERTIFICATE HOLDER CANCELLATION 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. 20E Main St Ashland, OR 97520 AUTHORIZED REPRESENTATIVE James A Hatton ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD From-INSURANCE MARKETPLACE 03/08/2017 08*41 #249 P_002/005 LAwco-1 PAGE Z NOTEPAD INSUREDS NAME Lawco Fire Protection LLC OP ID: DR DATE 03108117 included as 4dditional insured on a primary, non-contributory basis with regard to Commercial General per the attached forms (for ongoing and completed operations), and Excess Liability as it pertains to the named insured's operations in connection with the above captioned project(s) where required by contract. Waiver of subrogation in favor of the additional insureds applies where required by contract and allowable by law per the attached endorsement. From:INSURANCE MARKETPLACE 03/08/2017 08:41 #249 P_003/005 POLICY NUMBER: RFSCAK000154-01 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or O anization s : Locations Of Covered Operations Blanket where required by written contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section it - Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the folbwing additional exclu- organizgtion(s) shown in the Schedule, but only sions apply: with respect to, liability for "bodily injury', "property This insurance does not apply to "bodily injury" or damage or personal and advertising injury' "property damage" occurring after: caused, in whole or in part, by: 1. All work, including materials, parts or equip- 1. Your acts or omissions; or ment furnished in connection with such work, 2. The acts or omissions of those acting on your on the project (other than service, maintenance behalf; or repairs) to be performed by or on behalf of in the performance of your ongoing operations for the additional insured(s) at the location of the the addWnal insured(s) at the locatlon(s) desig- covered operations has been completed; or nated above. 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or orgardzation other than another contractor or suboontractor en- gaged in performing operations for a principal as a part of the same project. CO 2010 07 04 0 130 Properties, Inc., 2004 Page 1 of 1 O From-[NSURANICE MARKETPLACE 03/08/2017 08,41 4t249 P_004/005 COMMERCIAL GENERAL LIABILITY CG 20 0104 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROD UCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART The foilovAng is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary* primary and would not seek contribution Prntnary And Noncontributory Insurance from any other insurance available to the This insurance is primary to and will not seek addifional insured. contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured sunder such other insurance; and CO 20 01 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1 From-INSURANCE MARKETPLACE 03/08/2017 08.41 #249 P_005/005 POLICY NUMBER: RFSCAK000154-01 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THUS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following- COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anization s : Location And Description Of Completed Operations Blanket where required by written contract. r information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organizaticn(s) shown in the Schedule, but only with respect to (liability for "bodily injury' or "property dam- age" caused, in whole or in part, by "your work" at the locatiop designated and described in the sched- ule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". CG 20 37 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 D