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Home My WebLink AboutInsurance Certificate: Hassell Fabrication, Inc m_. ACOR°® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD"YYY) 6/4/2018 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: Leslie Weseman 1C. _ KPD Insurance, Inc. PHONE 503-892-0550 a/c No ; 503-892-0700 PO Box 29 Springfield OR 97477 AnnRess: lesliew@kpdinsurance.com INSURERS AFFORDING COVERAGE NAIC # wsURERA: Hartford Fire Insurance Co. 19682 INSURED HASS01C INSURER B Hassell Fabrication, Inc. 300 Dead Indian Memorial Rd INSURERC: Ashland OR 97520 INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1902544801 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y 52UUNSV7401 6/15/2018 6/1512019 EACH OCCURRENCE $1,000,000 CLAIMS-MADE lxl OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 300,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER'. GENERAL AGGREGATE $ 2,000,000 X POLICY F-] PRO ❑ LOC PRODUCTS - COMP/OP AGG $2,000,000 JECT OTHER $ A AUTOMOBILE LIABILITY 52UUNSV7401 6/15/2018 6115/2019 COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS X HIRED IX NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y / N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E. L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Property 52UUNSV7401 6/15/2018 6/15/2019 Special Form Replacement Cost $2,500 Deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Certificate holder is named as Additional Insured as respects to General Liability when required by written contract per HC 26 69 06 05. 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 Ave Ashland OR 97520 AUTHORIZED REPRESENTATIVE i 1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OREGON CHANGES - ADDITIONAL INSUREDS - AUTOMATIC STATUS WHEN REQUIRED BY WRITTEN CONTRACT, WRITTEN AGREEMENT OR PERMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Paragraph 61 of Section II, Who Is An Insured Is With respect to the insurance afforded to replaced by the following: these additional insureds, this insurance does not apply to: 6. Additional Insureds When Required By Written Contract, Written Agreement Or Permit "Bodily injury", "property damage" or f. Owners, Lessees Or Contractors -When "personal and advertising injury" arising out of Required In A Construction Agreement the rendering of, or the failure to render, any With You professional architectural, engineering or surveying services, including: Any owner, lessee or contractor when you The preparing' approving' or failing to and such person or organization have agreed in a construction contract or agreement that prepare or approve, maps, shop such person or organization be added as an drawings, opinions, reports, surveys, field - additional insured on your policy. Such orders, change orders or drawings and person or organization is an additional insured specifications; or s= only with respect to liability for "bodily injury", (2) Supervisory, inspection, architectural or "property damage" or "personal and engineering activities. advertising injury" caused by your negligence B. The following is added to Paragraph 6. of Section 11, or the negligence of those performing Who Is An Insured: operations on your behalf. 6. Additional Insureds When Required By _ (1) In the performance of your ongoing Written Contract, Written Agreement Or Permit operations for the additional insured; or (2) In connection with "your work" and g• Any Other Party = included within the "products-completed Any other person or organization who is not operations hazard", but only if an insured under Paragraphs a. through f. above, but only with respect to liability for _ (a) The written 'contract or agreement "bodily Injury", "property damage" or requires you to provide such "personal and advertising injury" caused, in coverage to such additional insured; whole or in part, by your acts or omissions or and the acts or omissions of those acting on your (b) This Coverage Part provides behalf: coverage for "bodily injury" or (1) In the performance of your ongoing "property damage" included within the operations; or "products-completed operations hazard". (2) In connection with your premises owned by or rented to you. Form HC 26 69 06 05 Page 1 of 1 ® 2005, The Hartford (Includes copyrighted material of Insurance Services Office, Inc. with its permission.)