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HomeMy WebLinkAboutInsurance Certificate - Earth Advantage, Inc °►`o CERTIFICATE OF LIABILITY INSURANCE DATE/YYYYI s/3112018 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 NFMEACT Kell! LUCK , Durham and Bates Agencies, Inc. PHONE FAX 720 SW Washington St. Ste250 E C.No EM: 503-224-5170 MC No): 503-221-0540 Portland OR 97205-3554 ADOREss: kellil@dbates.com INSURERS AFFORDING COVERAGE NAIC If INSURER A: Underwriters at Lloyd's London 15792 INSURED INSURERS: Ohio Security Insurance Company 24082 Earth Advantage, Inc. 623 SW Oak St, Ste 300 INSURER C: Portland OR 97205 INSURER O: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1294059328 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 UBft POLICY NUMBER MM/DDYfYYt7FY MM/DDY/YYYY LIMITS TR A X COMMERCIAL GENERAL LIABILITY PGIARK07385 611/2018 611/2019 EACH OCCURRENCE $1,000,000 CLAIMS-MADE I-XI OCCUR PREMISES Ea occurrence $100,000 MED EXP (Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMITAPPDES PER: GENERAL AGGREGATE $2,000,000 X POLICY PRO- ❑ ECT LOG PRODUCTS-COMP/OPAGG $2,000,000 OTHER $ A AUTOMOBILE LIABILITY PGIARK07385 61112018 6112019 COMBINED SINGLE LIMIT S Ea accident 1000000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) S AUTOS Ix HIRED AUTOS X AUTOS PROPERTY DAMAGE S A UMBRELLA LIAO X OCCUR PGIX600592 6/12018 6/12019 EACH OCCURRENCE $5,000,000 X EXCESS LIAR CLAIMS-MADE AGGREGATE $5,000,000 DED RETENTION$ $ WORKERS COMPENSATION PER AND EMPLOYERS' LIABILITY YIN STATUTE ER ANY OFFICEOPRIETEREXCLUOERrEXECUTIVE ON/A E. L. EACH ACCI DENT S (Mandatory in NH) E.L DISEASE-EA EMPLOYE $ antler s, descried OPERATIONS below POLICY LIMIT 5 DESCRIPTION SEASE- B Bus Pere Prop BKS57974M7 6/12018 6/12019 Limit 150.000 A Pmfessienal Liability PGIARK07385 6/12018 6/12019 Aggregate (ded. $5k) 2,000,000 Each Occur. 1,000,000 DESCMPVONOFOPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attachod if mom space is required) Additional Insured wording per attached form CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland -Administration & Conservation ACCORDANCE WITH THE POLICY PROVISIONS. A 20 ttn: Adam Hanksl Management Analyst East Main St AU NpapE As O REPRESENTATNE Ashland OR 97520 USA © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD Policy Number: PGIARK07385-00 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 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): Locations Of Covered Operations Any person(s) or organization(s) whom the Named Insured agrees, in a written contract, to name as an Additional insured. However, this status exists only for the project specified in that contract. Information required to complete this Schedule, 9 not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at' he location of the covered operations has been completed; or 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. CG 20 10 07 04