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HomeMy WebLinkAboutInsurance Certificate: JAM Construction dba Roofing A~~ ~ DATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 05,01,201, 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 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 endorsement(s). PRODUCER CONTACT NAME: Kristi R Dolmage Hart Insurance Agency -Medford PHONE FAX PO Box 1240 AIC No Ext: 1541) 779-4232 AIC No: E-MAIL ADDRESS: Grants Pass OR 97528 INSURER S AFFORDING COVERAGE NAIC # INSURER A : SAIF Corporation 36196 INSURED (541) 601-1221 INSURERB: Cincinnati Specialty Underwrit JAM Construction Inc dba Jam Roofing INSURER C 682 Mountain View Drive INSURER D Medford OR 97504 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: Cert ID 3512 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 ADDL SUBR POLICY NUMBER MMIDDlYYYY MMIDDIYYYY LIMITS LTR B g COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR Y CSU0038810 05/01/2017 05/01/2018 PREMISES Ea occurrence $ 100, 000 MED EXP (Any one person) $ excluded PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2 , 0 00 , 0 00 POLICY PRO ~ LOC PRODUCTS-COMP/OPAGG $ 1,000,000 JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY (Per person} $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION A AND EMPLOYERS'LIABILITY YEN 974161 10/01/201610/01/2017 % STATUTE ERH ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 500, 000 OFFICER/MEMBEREXCLUDED? ❑ NIA (Mandatory in NH) E.L. DISEASE-EA EMPLOYEE $ 500,000 If yes. describe under DESCRIPTION OF OPERATIONS below ~ E.L. DISEASE - NOLICY LIMIT $ 500, 000 DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) certificate holder is additional insured per attached form CSGA4035 0612 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 Public Works Dept. 20 E. Main Street AUTHORIZED REPRESENTATIVE Ashland OR 97520 ~{'G~YIC~-~ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Page 1 of 1 POLICY NUMBER:CSU0038810 COMMERCIAL GENERAL LIABILITY CSGA 4035 0612 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 speafied in any written contract or the person(s) or organization(s) shown in the agreement or in the Dedarations of this Cov- Schedule, but only to the extent that the liabil- erage Part, whichever is less. If no limits are ity for "bodily irury, "property damage" or speafied 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 orris- are those spedfied 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 Dedarations. 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 - tionalexclusions 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 contractor injury. written agreement executed prior to any loss 2. "Bodily injury', "property damage" or "per- that this insurance will be primary. This insur- ante will be noncontributory only if you have sonal and advertising injury for which the 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 0612 Services Office, Inc., with its permission. Page 1 of 1