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HomeMy WebLinkAboutInsurance Certificate: Van Row Mechanical Inc. VAN RO-1 OP ID- KA A~'ORO F DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 03/13/2018 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 endorsements . 503-357-7111 CONTACT Ka Andrew PRODUCER ! NAME: Kay Pacific Insurance Partners PHONE 503-357-7111 FAX 503-359-0340 www.pacificinspartners.com (A/C, No, Ext): (A/O, No): P. O. Box 327 E-MAIL SS: kay@pacificinspartners.com Forest Grove, OR 97116 Forest Grove House - INSURER(S) AFFORDING COVERAGE __NAIC # INSURER A : Gemini Insurance Company INSURED Van ROW Mechanical Inc [INSURER B: Kinsale Insurance Company PO Box 3813 SAIF Corporation 36196 Central Point, OR 97502 INSURER C : 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' TYPE OF INSURANCE ADDL SUBR, POLICY NUMBER POLICY EFF ! POLICY EXP LIMITS IMMIDDIY A X COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE $ CLAIMS-MADE X OCCUR VCGP023575 03112/2018 03112/2019 DAMAGE TO RENTED 1,000,000 Y PREMISES (Ea occurrencel_ $ MED EXP (Any one person $ 15'000 PERSONAL & ADV INJURY $ 1'000'000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2'000'000 POLICY X JPE -1 LOC PRODUCTS - COMP/OP AGG $ 2,000,000 i OTHER (Ea accident) - - OMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY C ANY AUTO BODILY INJURY Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS y~/ BODILY INJURY (Per accident) $ AUTOS ONLY A~ OS ONLDY (Per DAMAGE Peraccident) $ B UMBRELLA LIAR X OCCUR F1~CH OCCURRENCE $ 2'000'000 X EXCESS LIAR _ CLAIMS-MADE 01000633880 03/12/2018 03112/2019 2,000,000 AGGREGATE $ DED RETENTION $ C WORKERS COMPENSATION X PER OTH- AND EMPLOYERS' LIABILITY STATUTE Y/N 760659 05101/2017 05/01/2018 2,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E L_ EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E L DISEASE EA EMPLOYEE $ 2,000,000 If yes describe under I 21000,000 DESCRIPTION OF OPERATIONS below E L DISEASE -POLICY LIMIT i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Ashland, Oregon and its elected officials, officers and employees are additional insureds to the extent of coverage under form CG2010 0413. CERTIFICATE HOLDER CANCELLATION AS H LA-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland, Oregon ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main St Ashland, OR 97520 AUTHORIZED REPRESENTATIVE 1~61z ACORD 25 (2016103) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CG 20100413 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 Organization(s): Location(s) Of Covered Operations For Non-Residential and Non-Mixed use projects For Non-Residential and Non-Mixed use projects only. Any person or organization when you have only. All locations for which you have agreed in a agreed in a written and executed contract, prior to written and executed contract prior to an an "occurrence", that such person or organization be "occurrence" added as an additional insured on your policy. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended 2. If coverage provided to the additional to include as an additional insured the insured is required by a contract or person(s) or organization(s) shown in the agreement, the insurance afforded to such Schedule, but only with respect to liability for additional insured will not be broader than "bodily injury", "property damage" or "personal that which you are required by the contract and advertising injury" caused; in whole or in or agreement to provide for such additional part, by: insured. 1. Your acts or omissions; or B. With respect to the insurance afforded to 2. The acts or omissions of those acting on these additional insureds, the following your behalf; additional exclusions apply: in the performance of your ongoing operations This insurance does not apply to "bodily injury" for the additional insured(s) at the location(s) or "property damage" occurring after: designated above. 1. All work, including materials, parts or However: equipment furnished in connection with such work, on the project (other than 1. The insurance afforded to such additional service, maintenance or repairs) to be insured only applies to the extent performed by or on behalf of the additional permitted by law; anc insured(s) at the location of the covered operations has been completed: or CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 2. That portion of 'your work out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations, whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 10 04 13 ® Insurance Services Office, Inc., 2012 Page 2 of 2