Loading...
HomeMy WebLinkAboutInsurance Certificate: JAM Construction Inc. ~ l ® ~ r DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 04/27/2018 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: Thomas Insurance Agency PHONE- ICaldtmski FAX PO Box 1240 A( /C No,_Ext: __(541) 779-4232 A/C No: (541) 772-3963 E-MAIL Grants Pass OR 97528 ADDRESS: _ INSURERS AFFORDING COVERAGE NAIC # INSURER A: SAIF corporation 36196 INSURED (541) 601-1221 INSURER B: Cincinnati Specialty Underwrit 13037 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 7324 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 COND!T!ONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR' POLICY EFF POLICY EXP LIMITS LTR INSD POLICY NUMBER MMIDD/YYYY MM/DDIYYYY B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 J IDAMAGE TO RENTED CLAIMS-MADE X OCCUR Y CSU0038810 05/01/2018 05/01/2019' PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ excluded PERSONAL B ADV INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY F-] PRO ❑ LOC PRODUCTS -COMP/OP AGG $ 1,000,000 JECT 1~ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident _ ANY AUTO BODILY INJURY (Per person) $ OWNED L SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE is AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ IPER - STATUTE ERH A AND EMPSLOYYERSERS' L'LIABISATILIT TY Y/N 974161 110/01/2017 10/01/2018 X AND EMP ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ E.L. EACH ACCIDENT $ 500,000 OFF ICE R/MEMBER EXCLUDED? NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under f:F, CRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 500 , 000 $ $ DESCRIPTION OF OPERATIONS I LOCATIONS I 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 ©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 I POLICY NUMBER: CSU0038810 COMMERCIAL GENERAL LIABILITY CSGA 4035 06 12 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 specified in any written contract or the person(s) or organization(s) shown in the agreement or in the Declarations of this Cov- Schedule, but only to the extent that the liabil- erage Part, whichever is less. If no limits are ity for "bodily irjury, "property damage" or specified 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 omis- are those specified 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 Declarations. 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 - tional exclusions apply: COMMERCIAL GENERAL LIABILITY CON- DITIONS, 4. Other Insurance is amended 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 contract or injury. written agreement executed prior to any loss 2. "Bodily in'urye' property damage" or "per- that this insurance will be primary. This insur- sonal and advertising inju y/"for which the ance will be noncontributory only if you have 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 06 12 Services Office, Inc., with its permission. Page 1 of 1