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HomeMy WebLinkAboutInsurance Certificate: Garris Dust Control Service Corp (2) GARRDUS-01 S ARIANI '~e~vRO CERTIFICATE OF LIABILITY INSURANCE FDATE 0 (MM/DDmrY) 06/28/2018 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). CONTACT Sam Pariani PRODUCER NAME: Medford Office PayneWest Insurance, Inc. (A/JCO,N Ext): (541) 282-1413 (AJC, No): 38 North Central Ave. Ao RIESS: spariani@paynewest.com Medford, OR 97501 INSURER(S) AFFORDING COVERAGE NAIC # INsuRER A: Western National Mutual Insurance Company 15377 INSURED INSURER B : Western National Assurance Company 24465 Garris Dust Control Service Corp I INSURER c : PO Box 2592 INSURER D : White City, OR 97503 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 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 SUBR POLICY NUMBER POLICY EFF POLICY EXP 1 (MMIDDfYYYYI LIMITS LTR A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X CPP102581208 06/19/2018 06/19/2019 PREM SES Ea occurrence) $ 100'000 MED EXP (Any one person) $ 5'000 PERSONAL& ADV INJURY $ 1'000'000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO LOC PRODUCTS -COMP/OP AGG $ 2,000,000 JECT OTHER: EPLI $ 100,000 B COMBINED SINGLE LIMIT 1,000,000 AUTOMOBILE LIABILITY (Ea accident) $ ANY AUTO CPP102544308 06/19/2018 06/1912019 BODILY INJURY (Per person) $ OWNED X SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident). $ IRE NON-OWNED H PROPERTY DAMAGE AUTOSDONLY AUTOS ONLY (Per accident) $ X S UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DIED RETENTION $ $ WORKERS COMPENSATION PER AND EMPLOYERS' LIABILITY Y / N STATUTE ER H E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE N/A WFICER/MEIMBER EXCLUDED? l(~mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Ashland, Oregon, and it's Elected Officials, Officers and Employees are Additional Insureds As respects operations of the Named Insured when required by written contract as per attached endorsement #WNGL49 (07/15) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Engineering Division Attn: Becky Harshman 20 E. Main St AUTHORIZED REPRESENTATIVE Ashland, OR 97520 ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY WNGL490715 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 in- B. With respect to the insurance afforded to these ad- clude as an additional insured any person or or- ditional insureds, the following additional exclusion ganization for whom you are performing opera- applies: tions when you and such person or organization This insurance does not apply to: have agreed in writing in a contract or agreement that such person or organization be added as an 1. "Bodily injury", "property damage" or "personal additional insured on your policy. Such person or and advertising injury" arising out of the ren- organization is an additional insured only with re- dering of, or the failure to render, any profes- spect to liability for "bodily injury". "property dam- sional architectural, engineering or surveying age" or "personal and advertising injury" caused, services, including: in whole or in part, by: a. The preparing, approving, or failing to pre- 1. Your acts or omissions; or pare or approve, maps, shop drawings, opinions, reports, surveys, field orders, 2. The acts or omissions of those acting on your change orders or drawings and specifica- 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 negligence operations for that additional insured are com- or other wrongdoing in the supervision, hiring, pleted. employment, training or monitoring of others However: by that insured, if the "occurrence" which caused the "bodily injury" or "property dam- 1. The insurance afforded to such additional by age", or the offense which caused the "person- sured only applies to the extent permitted by al and advertising injury', involved the render- law; and ing of or failure to render any professional 2. If coverage provided to the additional insured services by you with respect to your providing is required by a contract or agreement, the in- engineering, architectural or surveying serv- surance afforded to such additional insured ices in your capacity as an engineer, architect will not be broader than that which you are re- or surveyor. quired by the contract or agreement to provide for such additional insured. WN GL 49 07 15 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 2 2. "Bodily injury" or "property damage" occurring D. The following is added to the Other Insurance after: Condition and supersedes any provision to the contrary: a. All work, including materials, parts or equipment furnished in connection with Primary And Noncontributory Insurance such work, on the project (other than serv- This insurance is primary to and will not seek ice, maintenance or repairs) to be per- any contribution from any other insurance formed by or on behalf of the additional in- available to an additional insured under your sured(s) at the location of the covered op- policy provided that: erations has been completed; or 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 oper- primary and would not seek contribution ations for a principal as a part of the same from any other insurance available to the project. additional insured. C. With respect to the insurance afforded to these ad- ditional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is re- quired 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 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 2