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HomeMy WebLinkAboutInsurance Certificate: Peck Smiley Ettlin Architects (2) DATE (MM/DDIYYYY) AR13 CERTIFICATE OF LIABILITY INSURANCE 3/13/2017 THIS CERTIFICATEIS 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 have ADDITIONAL INSURED provisions or 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 endorsements . PRODUCER CONTACT NAME: BROWN&BROWN NORTHWEST/PHS ~AICNo,EXt): (866) 467-8730 LAIC N.): (888) 443-6112 E-ML 709437 P: (866) 467-8730 F: (888) 443-6112 A DDRESS: PO BOX 33015 INSURER(S) AFFORDING COVERAGE NAIC# SAN ANTONIO TX 7 8 2 6 5 INSURERA: Hartford Casualty Ins Co INSURED INSURER B : PECK, SMILEY, ETTLIN ARCHITECTS INC. INSURER C: NED PECK, STEVE SMILLEY, &HANS ETTLIN INSURER D: 4412 SW CORBETT AVE INSURER E: PORTLAND OR 97239 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 TYPE OF INSURANCE ADD SUB POLICYNUMBER POLICYEFF POLICYEAP (MM/DD/IT LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s2, 000, 000 -1 1XI CLAIMS-MADE OCCUR DAMAGE TO RENTED 5 3 0 0, 0 0 0 PREMISES (Ea occurrence) A X General Liab x 52 SBA UL7992 04/01/2017 04/01/2018 MED EXP (Any one person) $10,000 PERSONAL: ADV INJURY s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 4 r 000, 000_ POLICY LX PRO ❑ LOC PRODUCTS - COMP/OP AGG s4,000,000 JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5 2, 000, 000 (Ea accident) ANY AUTO BODILY INJURY (Per person) $ A OWNED SCHEDULED 52 SBA UL7992 04/01/2017 04/01/2018 BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ S X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $1,000,000 A EXCESS LIAB CLAIMS-MADE 52 SBA UL 7 9 9 2 04/01/201'7 04/01/2018 AGGREGATE $1, 000,000 DE X RETENTION $10 , 0 0 0 $ WORSERSCOMPENSA77ON PER OTH- ANDEMPLOYERWLL467LITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVEY/N E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? AVA (Mandatory in NH) ❑ E.L. DISEASE- EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIP77ONOFOPERATIONS /LOCATIONS/ VEHIqWWRD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE City of Ashland, It's Officers DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Employees, and Agents. AUTHORIZED REPRESENTATIVE 20 East Main Street 7a--z- Ashland, OR 97520 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD