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HomeMy WebLinkAboutInsurance Certificate: Greenway Spray LLC .a o DATE(MMIDDIYYYY) u. CERTIFICATE OF LIABILITY INSURANCE 02/07/2019 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). PRODUCERTowne Centre Insurance Service,LLC CNAIYEAOT BRIAN SEAGOE _ _ 315 SE 7th Street PHONE 541 763311 FAX 541 476-5626 (Alc.No.Exit )4 (NC,No):( ) Grants Pass OR 97526 E-MAIL Brianry/��scis.biz ___ I ADDRESS:Brian@tcis.biz AFFORDING COVERAGE NAICC INSURER A:Scottsdale Insurance Company . INSURED GREENWAY SPRAY LLC INSURERB:Artisan and Truckers Casualty Co • 3155 OLD STAGE RD INSUaERC:Navigators Specialty Insurance Co 1 CENTRAL POINT OR 97502 --_.-- INSURER O: _"--- !- 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 AAODL SUILA POLICY EFF POLICY EXP LTR TYPE OF INSURANCE p4SDAVARI POLICY NUMBER (MMIDDNYYY) IMMJDD/YYVY)I LIMITS wi COMMERCIAL GENERAL LIABILITY CPS-2929545 02/1512019 102115/2020 LEACH OCCURRENCE $1,000,000 A I CLAIMS MADE DAMAGE TO RENTED 100,000 OCCUR PREMISES Ea occurrence) $MED EXP • Lone person) $5,000 . _ PERSONAL&ADV INJURY $1,000,000 • GENT.AGGREGATE LIMIT APPLIES PER I GENERAL AGGREGATE _ $2,000,000_- _ i POLICY LOC PRODUCTS-COMPlOP AGO $2,000,000_ OTHER: ���� 1 $ AUTOMOBILE LIABILITY I w lit 103967552-2 12/08/2018.,112 08/2019: (Ea accident) t51NGLE LIMIT $1,000,000 B • ANY AUTO••• • . It ,I r , _ ff - BODILY INJURY(POrPerson)i $ C!:rat'-'''F•I "—. .OWNED - SCHEDULED ir ' ' �- _ AUTOS ONLY • AUTOS - - 1 BODILY INJURY(Per accident) S • • HIRED NON-OWNED _ PROPERTY DAMAGE. - - -- • -^ • AUTOS ONLY �- AUTOS ONLY - .' (Per acpdentl _.- 1 - .. 5 UMBRELLA UAB ✓ OCCUR Li U NYI9EXCNO055701 02/15/2019 02/1512020 EACH OCCURRENCE s 2,000,000 C V EXCESSUAB CLAIMS-MADE AGGREGATE 52,000,000 DED I l RETENTIONS I $ __.__- -- - WORKERS COMPENSATION u I5T TUTS I I W- AND EMPLOYERS'LIABILITY ANYPROPRIETORIPARTNERIFVFCUTIVE Y/❑N N/A EL EACH ACCIDENT $ OFFICERIMEMBEREXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT 5 LJLJ I I DO DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additlnnal Remarks Schedule,may be attached If more apace Is required) Certificate holder Is listed as an additional Insured. • .CERTIFICATE HOLDER , CANCELLATION - CITY'OF ASHLAND ` _ - - • 20 EAST MAIN ST C-. -. --" • SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ASHLAND;,OR-97520 THE EXPIRATION DATE THEREOF, NOTICE WILL_ B.E DELIVERED IN . ACCORDANCE WITH THE POLICY PROVISIONS., - � VII"! -, AUTHORIZED REPRESENTATIVE '_ _ _ 1• /&a ©1988-20 CORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Produced using Forms Boss Web Software.www•FormaBoss.com(c)Impressive Publishing 500-208-1977 ENDORSEMENT SCOTTSDALE INSURANCE COMPANY NO ATTACHED TO AND ENDORSEMENT EFFECTIVE DATE FORMING A PART OF (12:01 A.M.STANDARD TIME) NAMED INSURED AGENT NO. POLICY NUMBER CPS2929545 02/15/2019 Greenway Spray LLC 46006 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT • 1 This endorsement modifies insurance provided under the following: 1 COMMERCIAL GENERAL LIABILITY COVERAGE PART With respect to this endorsement, SECTION II - WHO IS a. All work, including materials, parts or equip- AN INSURED is amended to include as an additional in- ment furnished in connection with such work, sured any person or organization whom you are required on the project (other than service, mainte- to add as an additional insured on this policy under a writ- nance or repairs) to be performed by or on be- ten contract, written agreement or written permit which half of the additional insured(s) at the location must be: of the covered operations has been com- a. Currently in effect or becoming effective during pleted; or the term of the policy; and b. That portion of"your work"out of which the in- jury or damage arises has been put to its in- b. Executed prior to the "bodily injury," "property tended use by any person or organization damage,"or"personal and advertising injury." other than another contractor or subcontractor The insurance provided to these additional insureds is lim- engaged in performing operations for a princi- ited as follows: pal as a part of the same project. 1. That person or organization is an additional in- 3. The limits of insurance applicable to the additional sured only with respect to liability for "bodily insured are those specified in the written contract, injury," "property damage"or "personal and adver- written agreement or written permit or in the Decla- tising injury"caused, in whole or in part, by: rations for this policy, whichever is less. These lim- its of insurance are inclusive of, and not in addition a. Your acts or omissions; or to, the Limits of Insurance shown in the Declara- b. The acts or omissions of those acting on your tions for this policy. behalf. 4. Coverage is not provided for "bodily injury,""prop- A person's or organization's status as an additional erty damage," or "personal and advertising injury" insured under this endorsement ends when arising out of the sole negligence of the additional your operations for that additional insured are insured. completed. 5. The insurance provided to the additional insured 2. With respect to the insurance afforded to these ad- does not apply to "bodily injury," "property dam- ditional insureds, the following exclusions are age," or "personal and advertising injury" arising added to item 2. Exclusions of SECTION I - out of an architect's, engineer's or surveyor's ren- COVERAGES: dering of or failure to render any professional serv- 1 ices including: This insurance does not apply to "bodily injury," "property damage"or "personal and advertising in- jury"occurring after: Includes copyrighted material of ISO Properties,Inc.,with its perm ission. Copyright,ISO Properties,Inc.,2004 GLS-150s(7-06) Page 1 of 2 INSURED a. The preparing, approving or failing to prepare written contract specifically requires that this insur- or approve maps, shop drawings, opinions, re- ance be primary. ports, surveys, field orders, change orders or drawings and specifications; and When this insurance is excess, we will have no du- ' ty under SECTION I - COVERAGES to defend the b. Supervisory, inspection, architectural or engi- additional insured against any "suit"if any other in- neering activities. surer has a duty to defend the additional insured I against that "suit." If no other insurer defends, we 6. Any coverage provided hereunder will be excess will undertake to do so, but we will be entitled to over any other valid and collectible insurance avail- the additional insured's rights against all those oth- able to the additional insured whether primary, ex- erinsurers. cess, contingent or on any other basis unless a 1 I! , i I 1 a A J AUTHORIZED REPRESENTATIVE DATE IA 1 Includes copyrighted material of ISO Properties,Inc.,with its permission. Copyright,ISO Properties,Inc.,2004 GLS-150s(7-06) Page 2 of 2 i i • PROOREll/!/E Additional Insured Endorsement Name of Person or Organization City of Ashland 20 East Main St Ashland, OR 97520 The person or organization named above is an insured with respect to such liability::overage as is afforded by the policy but this insurance applies to said insured only as a person liable for the conduct of another insured and then only to the extent of that liability.We also agree with you that insurance provided by this endorsement will be primary for any power unit specifically described on the Declarations Page. Limit of Liability Bodily Injury each person/ each accident Property Damage each accident Combined Liability $1,000,000 each accident All other terms, limits and provisions of this policy remain unchanged. This endorsement applies to Policy Number: 03967552-2 Issued to(Name of Insured): GREENWAY SPRAY LLC Effective date of endorsement: 12/08/2018 Policy expiration date: 12/08/2019 Form 1198 (01/04)