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HomeMy WebLinkAboutInsurance Certificate: Portland Engineering Inc. (2) f DATE (MMIDD/YYYY) RO® CERTIFICATE OF LIABILITY INSURANCE IIII 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: Lynn Wray Ward Insurance Agency Inc. PHONE FAX PO Box 10167 A/c No Ext : 541-687-1117 A/c No): 541-342-8280 Eugene OR 97440 A R'ss: lynn@wardinsurance.net INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Cincinnati Specialty Underwriters Insurance Com an 13037 INSURED PORTENG-01 INSURER B : Cincinnati Insurance Company 10677 Portland Engineering Inc INSURER C : Commerce and Indust Insurance Company 19410 7675 High Banks Rd Ste 1 Central Point OR 97502 INSURER D : Continental Casualty 20443 INSURER E _ INSURER F COVERAGES CERTIFICATE NUMBER: 982936954 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 EFF POLICY EXP LIMITS LTR IN SD WVD POLICY NUMBER MMIDD/YYYY MMIDD/YYYY A X COMMERCIAL GENERAL LIABILITY Y Y CS00039055 7/1/2018 7/1/2019 EACH OCCURRENCE $1,000,000 Fvi TO CLAIMS-MADE OCCUR PREMISES DAMAGES(Ea RENTE occurD rence $ 100,000 MED EXP (Any one person) $ PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENE RAL AGGREGATE $2,000,000 H POLICY ❑ PRO- ❑ LOC PRODUCTS -COMP/OP AGG $ 2,000,000 JECT OTHER: $ B AUTOMOBILE LIABILITY Y Y ENP 0148589 7/112018 7/1/2019 COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident Nonowned & Hired Auto $ 1,000,000 C X UMBRELLA LIAR OCCUR EBU021332420 7/112018 7/1/2019 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y / N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ E. L. EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ D Pollution Liability MCH288379629 7/1/2018 7/1/2019 Limit $3,000,000 Ded: $5,000 Professional Liability Limit $3,000,000 Ded: $5,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder and all entities required by written contract are included as additional insureds on a primary and non-contributory basis with waiver of subrogation as respects to the general liability including completed operations and auto liability as required by written contract per attached endorsements. 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 City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. Attn: David Gies 20 E Main St AUTHORIZED REPRESENTATIVE Ashland OR 97520 i/ off © 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 Th13 insurance will be noncontributory only if CSGA4031 0612 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 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. tract or written agreement executed prior to and this coverage is determined to be primary. 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 consoli- organlzatlon be 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 specified 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- exclusions apply: erage Part, whichever is less. If no limits are specified 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, elusive 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- elude: 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 00 12 services Office, Inc., with its permission. Page 1 of 2 CSGA 4031 00 12 sarvice3 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 40871212 Services Office, Inc., with its permission. Page i 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 - Coverage 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) Gection I - Coverage C, which cannot be attrib- the "products-completed operations hazard" will uted only to ongoing operations at a single des- reduce the Products-completed Operations Ag- GENERAL AGGREGATE LIMIT ignated construction project shown in the Sched- 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 payments shall not reduce any Dcsig- still be deemed to be the same construction pro- rated Construction Project General Aggre- 1ect. gate Limit. E. The provisions of Section III - Limits Of Insur- Designated Construction Project(s): ance not otherwise modified by this endorsement When required by written contract. shall continue to apply as stipulated. Information required to con late 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 under 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 construction 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 in 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. Inst -ris: b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "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 E014 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. 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 TH S ENDORSEMENT CHANGES THE POL l00Y. PLEASE READ IT CAREFUL "','o This endorsement modifies insurance provided under the following: 3 _Zi LESS A 1 0 30)VERAG= 0RNI 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. 3lanket Waiver of Sub, rogation of payments we make for "bodily injury" or ~9®O- "property damage" arising out of the operation SECTION 6V - BUSINESS AUTO C® of T90N5, A. Loss Conditions, 5. Transfer of a covered "auto" 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 437.2 09 09