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HomeMy WebLinkAboutInsurance Certificate: Gew, LLC GEWLLCO-01 BSHINN st►coRO CERTIFICATE OF LIABILITY INSURANCE DATEIMMIDD/YYYY) 06/25/2018 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 NOMTACT Madras Office PHONE PayneWest Insurance, Inc. INC,, N , at): (541) 475-2249 WC, No):(541) 475-6842 P.O. Box 680 pOpAIE Madras, OR 97741 INSURERS AFFORDING COVERAGE NAIC a INSURER A: Western National Assurance Company 24465 INSURED INSURERS :National Union Fire Insurance Company of Pittsburgh, Pa 19445 GEW, LLC INSURER C: Hartford Insurance Co of 00914 PO BOX 2485 INSURER D :Pacific Indemnity Battle Ground, WA 98604 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 CONTRACTOR 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 pOLICV NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2'666'660 CLAIMS-0AADE X OCCUR CPP1168023 07/02/2018 07/02/2019 DAMAGE TO RENTED 100,000 X PREMISES amxurrence $ MED EXP An one erson $ 5'666 PERSONAL B ADV INJURY $ 2'600'660 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 4'000'000 POLICY 7087 FILOC PRODUCTS - COMP/OP AGO $ 4,000,000 OTHER. WASHINGTON STOP $ 1,000,000 A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,900,000 a amide $ X ANY AUTO CPP1168021 07102/2018 07102/2019 BODILY INJURY Per Person) $ OWNED P SCHEDULED AUTOS ONLY AUTOSSWN BODILY INJURY Per accident $ AUTOS ONLY AUTOSONLn %0PE 1ZDAMAGE $ B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5'666'666 EXCESS LIAR CLAIMS-MADE EBU021332410 0710212018 0710212019 AGGREGATE $ DED RETENTION$ $ C WORKERS COMPENSATION PER 0TH-STATUTE ANDEMPLOYERS'LIABILITY YIN 52WECKU6503 04/03/2018 04/0312019 1,000,000 ANY PROPRIETORIPARTNER/EXECUTIVE ❑ E.L. EACH ACCIDENT $ WFICER/MF,MB NH) ER EXCLUDED? N/A andatorym _ E.L. DISEASE - EA EMPLOYE $ 1'666'666 If yes, desmbe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ D Professional Liabili 82500642 07/02/2018 07/0212019 Occurrence/Aggregate 3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached U more space is required) City of Ashland Project name: Safety Training (onslte for Public Works & Electric Utility Departments) The City of Ashland, OR and it's elected officials, its officers, and employees are included as an additional insured for general liability if required by written contract pursuant to the attached WNGL500715 endorsement with primary and non-contributory included per the attached WNG500715. 30 day cancel notice applies CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN tY ACCORDANCE WITH THE POLICY PROVISIONS. 90 N. Mountain Ave Ashland, OR 97520 AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) ©1988.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY WN GL 49 07 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU PRIMARY AND NONCONTRIBUTORY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II - Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured any person or or- additional insureds, the following additional exclu- ganization for whom you are performing opera- sion applies: tions when you and such person or organization This insurance does not apply to: have agreed in writing in a contract or agreement 1. "Bodily injury", "property damage" or "personal that such person or organization be added as an and advertising injury" arising out of the ren- additional insured on your policy. Such person or dering of, or the failure to render, any profes- organization is an additional insured only with re- sional architectural, engineering or surveying spect to liability for "bodily injury", "property dam- services, including: age" or "personal and advertising injury" caused, a. The preparing, approving, or failing to pre- in whole or in part, by: pare or approve, maps, shop drawings, 1. Your acts or omissions; or opinions, reports, surveys, field orders, 2. The acts or omissions of those acting on your change orders or drawings and specifica- behalf; tions; or in the performance of your ongoing operations for b. Supervisory, inspection, architectural or the additional insured. engineering activities. A person's or organization's status as an additional This exclusion applies even if the claims insured under this endorsement ends when your against an additional insured allege negli- operations for that additional insured are complet- gence or other wrongdoing in the supervision, ed. hiring, employment, training or monitoring of However: others by that insured, if the "occurrence" 1. The insurance afforded to such additional in- which caused the "bodily injury" or "property sured only applies to the extent permitted by damage", or the offense which caused the law; and "personal and advertising injury", involved the rendering of or failure to render any profes- 2. If coverage provided to the additional insured sional services by you with respect to your is required by a contract or agreement, the in- providing engineering, architectural or survey- surance afforded to such additional insured ing services in your capacity as an engineer, will not be broader than that which you are re- architect or surveyor. quired by the contract or agreement to provide for such additional insured. WN GL 49 07 15 Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 2. "Bodily injury" or "property damage" occurring D. The following is added to the Other Insurance after: Condition and supersedes any provision to the a. All work, including materials, parts or contrary: equipment furnished in connection with Primary And Noncontributory Insurance such work, on the project (other than ser- This insurance is primary to and will not seek vice, maintenance or repairs) to be per- formed by or on behalf of the additional in- any contribution from any other insurance sured(s) at the location of the covered available to an additional insured under your operations has been completed; or policy provided that: b. That portion of "your work" out of which (1) The additional insured is a Named Insured the injury or damage arises has been put under such other insurance; and to its intended use by any person or or- (2) You have agreed in writing in a contract or ganization other than another contractor or agreement that this insurance would be subcontractor engaged in performing op- primary and would not seek contribution erations for a principal as a part of the from any other insurance available to the same project. additional insured. C. With respect to the insurance afforded to these additional insureds, the following is added to Sec- tion 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: 1. The minimum amount required by the contract or agreement; or 2. The Limits of Insurance shown in the Declara- tions; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. WN GL 49 07 15 Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission.