Loading...
HomeMy WebLinkAboutInsurance Certificate: Budlets Glass Services Inc. QD DATE (MMIDDIYYYY) A`~ o CERTIFICATE OF LIABILITY INSURANCE 03/01/2018 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: Tom Kaldunski Hart Insurance Agency PHONE FAX PO Box 1240 A/C,No,Ext):- (541) 779-4232_ (A/C,N.): (541_) 772-3963 E-MAIL ADDRESS: Grants Pass OR 97528 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Cincinnati Specialty Underwrit 13037 INSURED (541) 773-5881 INSURER B: Cincinnati Insurance Company 10677 Butlers Glass Service Inc. INSURER C dba Bill's Glass INSURER D 319 E McAndrews Road Medford OR 97501 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBE=R: Cert IA 6631 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 SUER POLICY NUMBER MM LTR ! DIYYYY MM DDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 ~DAMAGE TO RENTED CLAIMS-MADE L _X OCCUR Y CSU0079916 ,02/19/2018 02/19/2019 PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY [ X ] PRO JECT El LOC PRODUCTS -COMP/OP AGG $ 2,000,000 - OTHER: $ ) SINGLE LIMIT $ 1,000,000 AUTOMOBILE LIABILITY ECOMBIa accidentdent B X ANY AUTO EBA 0374731 02/19/2018 02/19/2019 BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS $ HIRED NON-OWNED PROPERTYDAMAGE AUTOS ONLY AUTOS ONLY (Par accident _ A UMBRELLA LIAB X OCCUR CSU0086650 02/19/2018 02/19/2019 EACH OCCURRENCE $ 1,000,000 X EXCESSLIAB CLAIMS-MADE AGGREGATE $ 1,000,0_0_0 DED RETENTION$ Aggregate $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY YIN I_STATUTE ER - ANYPROPRIETOR/PARTNERlEXECUTIVE F7 N /A E.L. EACH ACCIDENT $ _ OFFICER/MEMBER EXCL UDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes. desclbe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ $ $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) certificate holder is listed as additional insured per attached forms CSGA4032 12/13 and waiver CSGA4087 12/12 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 90 N Mountain AUTHORIZED REPRESENTATIVE ~{GrlCe Ashland OR 97520 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 1 POLICY NUMBER:CSU0079916 COMMERCIAL GENERAL LIABILITY CSGA 40321213 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - SCHEDULED PERSON OR ORGANIZATION - COMPLETED OPERATIONS ONLY (LIMITED) This endorsement modifies insurance provided under the following: PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or Organization(s): As Required by Written Contract. A. SECTION II - WHO IS AN INSURED is b. Supervisory, inspection, architectural amended to include as an additional insured or engineering activities. any person or organization shown in the schedule, but only with respect to "bodily in- 2. "Bodily injury" or "property damage" aris- jury" or "property damage" caused by "your ing out of 'your work" for which a consoli- work" performed for the additional insured and dated (wrap-up) insurance program has included in the "products-completed opera- been provided by the prime contrac- tions hazard". for/project manager or owner of the con- struction project in which you are involved. However: 3. "Bodily injury" or "property damage" to any 1. The insurance afforded to such additional employee of you or to any obligation of insured only applies to the extent permit- the additional insured to indemnify an- ted by law; and other because of damages arising out of such injury. 2. If coverage provided to the additional in- sured is required by a contract or agree- 4. "Bodily injury" or "property damage" for ment, the insurance afforded to such ad- which the Named Insured is afforded no ditional insured will not be broader than coverage under this policy of insurance. that which you are required by the con- tract or agreement to provide for such ad- C. With respect to the insurance afforded to ditional insured. these additional insureds, SECTION III - LIM- ITS OF INSURANCE is amended to include: B. With respect to the insurance afforded to these additional insureds, the following addi- The limits applicable to the additional insured tional exclusions apply: are those specified in any written contract or agreement or in the Declarations of this Cov- This insurance does not apply to: erage Part, whichever is less. If no limits are 1. "Bodily injury"or "property damage arising specified in any written contract or agreement, the limits applicable to the additional insured out of the rendering of, or the failure to are those specified render, any professional architectural, en- in the Declarations of this Coverage Part. The limits of insurance are en- gineering or surveying services, including: clusive of and not in addition to the limits of in- a. The preparing, approving, or failing to surance shown in the Declarations. prepare or approve, maps, shop D. With respect to the insurance afforded to drawings, opinions, reports, surveys, these additional insureds, SECTION IV - field orders, change orders or draw- COMMERCIAL GENERAL LIABILITY CON- ings and specifications; or DITIONS, 4. Outer Insurance is amended to include: Includes copyrighted material of insurance CSGA 4032 12 13 Services Office, Inc., with its permission. Page 1 of 2 Any coverage provided herein will be excess any loss that this insurance will be primary. over any other valid and collectible insurance This insurance will be noncontributory only if available to the additional insured whether you have so agreed in a written contract or primary, excess, contingent or on any other written agreement executed prior to any loss basis unless you have agreed in a written con- and this coverage is determined to be primary. tract or written agreement executed prior to Includes copyrighted material of insurance CSGA 4032 12 13 Services Office, Inc., with its permission. Page 2 of 2 i COMMERCIAL GENERAL LIABILITY CSGA 40871212 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US - PER CONTRACT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to Paragraph 8. Transfer of Rights of Recovery Against Others to Us of SECTION IV-CONDITIONS: If you have agreed, in a written contract or agreement, to provide a waiver of any right of recovery against a person or organization, we will waive any right of recovery we may have against that person or organization because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products-completed operations hazard". This waiver applies only to that person or organization for which you have agreed to in a written contract to provide said waiver. Includes copyrighted material of Insurance CSGA 40871212 Services Office, Inc., with its permission. Page 1 of 1