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HomeMy WebLinkAboutInsurance Certificate: Portland Engineering Inc. A<7"R" CERTIFICATE OF LIABILITY INSURANCE F DATE (MM/DD YYYY) 6/27/2018 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: Ward Insurance Agency Inc. PHONE FAX, No): 541-342-8280 PO Box 10167 A/c No Ext : 541-687-1117 Eugene OR 97440 E-MAIL ADDRESS: tina@wardinsurance.net INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Cincinnati Surplus & Excess 13037 INSURED PORTENG-01 INSURER B : Portland Engineering Inc 7675 High Banks Rd Ste 1 INSURERC: Central Point OR 97502 INSURER D : INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 254532969 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 INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CS00039055 7/1/2017 7/1/2018 EACH OCCURRENCE $1,000,000 CLAIMS-MADE I OCCUR DAMAGE RENTED PREMISES (Ea occurrence $ 100,000 MED EXP (Any one person) $ Excluded PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 Fy7 POLICY JECOT- 7 LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ 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. DISFASE - EA EMPLOYEE $ If yes, describe. Linder DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / 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 named as additional insured on a primary and non-contributory basis including waiver of subrogation and completed operations per the attached CSGA4031 & CSGA4087. Designated construction project(s) general aggregate limit applies per attached CG2503. All when required by written contract. All is subject to policy limits, terms, conditions and exclusions. 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 20 E Main St Ashland OR 97520 AUTHORIZED REPRESENTATIVE jam': ~ 'r°n= © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY available to the additional insured whether Thi3 insurance will be noncontributory only if CSGA4031 06 12 primary, excess, contingent or on any other you have so agreed in a written contract or basis unless you have agreed in a written con- written agreement executed prior to any loss tract or written agreement executed prior to and this coverage is determined to be primary. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. any loss that this insurance will be primary. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU - OPERATIONS AND COMPLETED OPERATIONS (LIMITED) This endorsement modifies insurance provided under the following. COMMERCIAL GENERAL LIABILITY COVERAGE PART A. SECTION II - WHO IS AN INSURED is b. Supervisory, inspection, architectural amended to include as an additional insured or engineering activities. any person or organization when you and such person or organization have agreed in writing 2. "Bodily Injury' or "property damage" aris- in a contract or agreement that such person or ing out of "your work" for which a eonsoli- organlzatlon to added as an additional Insured dated (wrap-up) insurance program has on your policy, but only to the extent that the li- been provided by the prime contractor / ability is caused by 'your work" performed for project manager or owner of the construc- that additional insured and only to the extent tion project in which you are involved. that such liability is caused by your negligence, 3. "Bodily injury", "property damage" or "per- acts or omissions or the negligence, acts or sonal and advertising injury' to any em- omissions of those acting on your behalf. ployee of you or to any obligation of the If not spedfied otherwise in the written con- additional insured to indemnity another tract or agreement, a person's or organiza- because of damages arising out of such tion's status as an additional insured under this injury. endorsement ends one year after your opera- 4. "Bodily injury% "property damage" or "per- tions for that additional insured are completed. sonal and advertising injury" for which the The written contract or agreement must be Named Insured is afforded no coverage currently in effect or become effective during under this policy of insurance. the term of this Coverage Part. The contract or agreement must be executed prior to the "bod- C. With respect to the insurance afforded to ily injury', "property damage" or "personal and these additional insureds, SECTION III - LIM- advertising injury" to which this endorsement ITS OF INSURANCE is amended to include: pertains. The limits applicable to the additional insured B. With respect to the insurance afforded to the- are those specified in the written contract or se additional insureds, the following additional agreement or in the Declarations of this Cov- exdusions apply: erage Part, whichever is less. If no limits are spedfed in the written contract or agreement, This insurance does not apply to: the limits applicable to the additional insured 1. "Bodily Injury', "property damage" or "per- are those specified in the Declarations of this sonal and advertising injury" arising out of Coverage Part. The limits of insurance are in- the rendering of, or the failure to render, clusive of and not in addition to the limits of in- any professional architectural, engineer- surance shown in the Declarations. ing or surveying services, including: D. With respect to the insurance afforded to the- a. The preparing, approving, or failing to se additional insureds, SECTION IV - COM- prepare or approve, maps, shop MERCIAL GENERAL LIABILITY CONDI- drawings, opinions, reports, surveys, TIONS, 4. Other Insurance Is amended to In- field orders, change orders or draw- clude: ings and specifications; or Any coverage provided herein will be excess over any other valid and collectible insurance Includes copyrighted material of Insurance Includes copyrighted material of Insurance CSGA 4031 OG 12 services Office, Inc., with its permission. Page 1 of 2 CSGA 4031 00 12 services Office, Ina, with its permission. Page 2 of 2 COMMERCIAL GENERAL LIABILITY CSGA 408712 12 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US - PER CONTRACT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to Paragraph 8. Transfer of Rights of Recovery Against Others to Us of SECTION IV - CONDITIONS: If you have agreed, in a written contract or agreement, to provide a waiver of any right of recovery against a person or organization, we will waive any right of recovery we may have against that person or organization because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products-completed operations hazard". This waiver applies only to that person or organization for which you have agreed to in a written contract to provide said waiver. Includes copyrighted material of Insurance CSGA 4087 12 12 iervices Office, Inc., with its permission. Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 25 03 05 09 B. For all sums which the insured becomes legally C. When coverage for liability arising out of the obligated to pay as damages caused by "occur- "products-completed operations hazard" is pro- THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. rences" under Section I - overage A, and for all vided, any payments for damages because of medical expenses caused by accidents under "bodily injury" or "property damage" included in DESIGNATED CONSTRUCTION PROJECT(S) Section I - Coverage C, which cannot be attrib- the "products-completed operations hazard" will GENERAL AGGREGATE LIMIT iguted naonly ongoing operations a single des- reduce the Products-completed Operations Ag- ignated construction project shown n in the Schad- gregate Limit, and not reduce the General Ag- ule above: gregate Limit nor the Designated Construction 1. Any payments made under Coverage A for Project General Aggregate Limit. damages or under Coverage C for medical D. If the applicable designated construction project This endorsement modifies insurance provided under the following: expenses shall reduce the amount available has been abandoned, delayed, or abandoned under the General Aggregate Limit or the and then restarted, or if the authorized contract- COMMERCIAL GENERAL LIABILITY COVERAGE PART Products-completed Operations Aggregate ing parties deviate from plans, blueprints, de- Limit, whichever is applicable; and signs, specifications or timetables, the project will SCHEDULE 2. Such paYmenu shell not reduce any Dc3i9- still be deemed to be the same construction pro- nated Construction Project General Aggre- ject. Designated Construction Project(s): gate Limit. E. The provisions of Section III - Limits Of Insur- ance not otherwise modified by this endorsement When required by written contract. shall continue to apply as stipulated. Information re uired to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally 3. Any payments made under Coverage A for obligated to pay as damages caused by "occur- damages or unde, Coverage C for medical rences" under Section I - Coverage A, and for all expenses shat! reduce the Designated Con- medical expenses caused by accidents under struction Project General Aggregate Limit for Section I - Coverage C, which can be attributed that designated construction project, Such only to ongoing operations at a single designated payments shall not reduce the General Ag- construction project shown in the Schedule gregate Limit shown in the Declarations nor above: shall they reduce any other Designated Con- t. A separate Designated Construction Project struction Project General Aggregate Limit for General Aggregate Limit applies to each des- any other designated construction project ignated corstruction project, and that limit is shown in the Schedule above. equal to the amount of the General Aggregate 4. The limits shown in the Declarations for Each Limit shown in the Declarations. Occurrence. Damage To Premises Rented To 2. The Designated Construction Project General You and Medical Expense continue to apply. Aggregate Limit is the most we will pay for the However, instead of being subject to the sum of all damages under Coverage A, ex- General Aggregate Limit shown in the Decla- cept damages because of "bodily injury" or rations, such limits will be subject to the appli- "property damage" included 'n the "products- cable Designated Construction Project Gen- completed operations hazard", and for medi- eral Aggregate Limit, cal expenses under Coverage C regardless of the number of: a. Incur-1s, b. Claims made or "suits" brought, or c. Persons or organizations making claims or bring~.ng "suits". CG 25 03 05 09 © Insurance Services Office, Inc , 2008 Page 1 of 2 ❑ Page 2 of 2 © Insurance Services Office, Inc., 2008 CG 25 03 05 09 ❑ THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY INSURANCE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM This endorsement changes the policy effective on the inception date of the policy unless another date Is indi- cated below. Endorsement Effective: Policy Number: 07-01-2018 EBA 014 85 89 Named Insured: I PORTLAND ENGINEERING INC Countersigned by: (Authorized Representative) With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. 1. Noncontributory Insurance SECTION IV - BUSINESS AUTO CONDI- TIONS, B. General Conditions, 5. Other In- surance is replaced by the following: c. Regardless of the provisions of Para- graph a. above, this Coverage Form's Li- ability Coverage is primary and we will not seek contribution from any other in- surance for any liability assumed under an "insured contract" that requires liability to be assumed on a primary noncon- tributory basis. AA 4174 11 05 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF SUBROGATION - AUTO This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM This endorsement changes the policy effective on the inception date of the policy unless another date is indi- cated below. Endorsement Effective: Policy Number: 07-01-2018 IEBA 014 85 89 Named Insured: PORTLAND ENGINEERING INC Countersigned by: (Authorized Representative) With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. 1. Blanket Waiver of Subrogation of payments we make for "bodily injury" or SECTION IV - BUSINESS AUTO CONDI- "Property damage" arising out of the operation of TIONS, A. Loss Conditions, 5. Transfer of a covered "auto" when you have assumed liability for such "bodily injury" or "property Rights of Recovery Against Others to Us is damage" under an "insured contract", pro- amended by the addition of the following: vided the "bodily injury" or "property damage" We waive any right of recovery we may have occurs subsequent to the execution of the "in- against any person or organization because sured contract". AA 4172 09 09