Loading...
HomeMy WebLinkAboutInsurance Certificate: Copeland Construction ~ l ® DATE (MMIDDIYYYY) A~ ° CERTIFICATE OF LIABILITY INSURANCE 6/2/2017 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 CONTACT â–ºTeSSlca Embree NAME: _ Zarosinski-Leavitt Ii1S Agency Of Oregon, IAC AION o Ext: (503) 639-4220 II (A~,No): (503)639-4449 Leavitt Group of Portland E-MAIL Jessica-embree@leavitt.com ADDRESS: 8285 SW Nimbus Ave, Ste 120 INSURER(S) AFFORDING COVERAGE ~I NAIC # Beaverton OR 97 008 INSURER A ;Cinclnnatl Insurance COmpany_ ~ 10677 INSURED INSURER B :SAIF ~ 036196 Copeland Construction LLC INSURER C ; 321 Pruett Rd. INSURER D INSURER E Eagle Point OR 97524 INSURER F COVERAGES CERTIFICATE NUMBER:17/18 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 TYPE OF INSURANCE ADDL SUBRj POLICY NUMBER MM1DDYlYYYY MMIDDYIYYYY LIMITS LTR X ~ COMMERCIAL GENERAL LIABILITY ~ 1 000 000 _ I ~ I ~CH OCCURRENCE _ $ _ ~ ~ ~ ~ ~ ~ DAMAGE TO RENTED A ~ CLAIMS-MADE ~ OCCUR ~ I PREMISES (Ea occurrence) i $ 100, 000 r EPP0441387 ~ 6/3/2017 6/3/2018 ~ MED EXP (Any one person) ~ $ 10, 000 I 1 000 000 PERSONAL & ADV INJURY ~ $ ~ ~ i ~ GEN'L AGGREGATE LIMIT APPLIES PER: i I ~ 1 !GENERAL AGGREGATE I $ 2, 000, 000 ~j POLICY ~ JE ~ ~ LOC ~ I ~ PRODUCTS - COMPIOP AGG ~ $ 2 ~ 000, 000 ~ ~ ~ OTHER: AUTOMOBILE LIABILITY ~ I ~ ~ I COMBINED SINGLE LIMIT $ 1, 000, 000 ~ (Ea accident) _ ~ I I ~ --t X i i ~ ~ BODILY INJURY (Per person) $ ANY AUTO ~ _ _ _ A ALL OWNED ~i SCHEDULED I', ~ EBA0441387 6/3/2017 I~ 6/3/2018 I BODILYINJURY(Peraccident) $ AUTOS AUTOS i ~ ~ j NON-OWNED ! ~ ~ I PROPERTY DAMAGE $ HIRED AUTOS ~ AUTOS ; i (Per accident) ' i ~ $ X UMBRELLA LIAB X OCCUR i I EACH OCCURRENCE I $ _ 1, 000, 000_ A EXCESS LIAB ~ ~ I _ I ii CLAIMS-MADE I AGGREGATE ~ $ 1, 000, 000 DED RETENTIONS EPP0441387 6/3/2017 6/3/2018 $ WORKERS COMPENSATION i I ~ PER ~ OTH- AND EMPLOYERS' LIABILITY Y 1 N ~ X STATUTE i ER ZANY PROPRIETOWPARTNERIEXECUTIVE i i ~ i ~ E.L. EACH ACCIDENT $ 500, 000 ~ OFFICERlMEMBER EXCLUDED? I N I A B (Mandatory in NH) !I i 980838 1/1/2017 ~ 1/1/2018 E.L. DISEASE - EA EMPLOYE $ 500, 000 If yes, describe under I DESCRIPTION OFOPERATIONS below ~ , E.L. DISEASE -POLICY LIMIT $ 500 000 I I~ I I DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 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 ~~~1C~ ©1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (201401)