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HomeMy WebLinkAboutInsurance Certificate: Pilot Rock (2) • r ^ • 7 ® DATE(MMIDDf/YYY) A�o CERTIFICATE OF LIABILITY INSURANCE 07/22/2019 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). PRODUCER CONTACT NAME: Kris ti R Dolmage Hart Insurance Agency PHONE FAX PO Box 1240 (A/C.NO.Ext): (541) 779-4232 (A/C,NO):(541) 772-3963 ADDRE Grants Pass OR 97528 SS: kdolmage®hartinsurance.Corn INSURER(5)AFFORDING COVERAGE NA/CI INSURERA:American Hallmark Insurance Co 43494 INSURED (541) 779-4916 INSURERS: Pilot Rock Excavation Inc. INSURER C: 5 S Stage Read INSURER O: Medford OR 97501 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:Cert ID 12941 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 SUER POLICY EFF I POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DDIYYYY)I(MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 TO RENTED CLAIMS-MADE X OCCUR 44CL494969 07/20/2019 07/20/2020 PREEMASES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL 8ADV INJURY $ 1,000,000 GENL AGGREGATE LIMITAPPUES PER: GENERAL AGGREGATE $ 2,000,000 O- POLICY X JET LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) 1,000,000 A X ANY AUTO 44CL494969 07/20/2019 07/20/2020 BODILY INJURY(Perperson) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) A X UMBRELLALIAB X OCCUR I 440749506 07/20/2019 07/20/2020 EACH OCCURRENCE $ 1,000,000 EXCESSLIAB CLAIMS-MADE AGGREGATE $ 1,000,000 OED X R 10 000 $ , WORKERSCOMPENSATION AND EMPLOYERSLIABILITY PER ER ANYPROPRIETOR/PARTNER/EXECUTIVE Y(� N/A E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED7 I I (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ yes, under FO ye, s d O cIOe un D OPERATIONS below I E.L DISEASE-POLICY LIMIT $ I 4 $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Additional insured form MP9767 10/10 attachedCity of Ashland and its employees, officers and agents are included as additional insured as respects to general liability and auto liability. 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 Public Works Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 20 E. Main Street AUTHORIZED REPRESENTATIVE Ashland OR 97520 , ✓ I I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Page 1 of 1 . General Liability Additional Coverages The following Additional Coverages are added to the COMMERCIAL GENERAL LIABILITY COVERAGE FORM. A. Blanket Additional Insured Coverage 1.SECTION II—WHO IS AN INSURED of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM is amended to include as an insured any person or organization(referred to as Additional Insured)whom you are required to add as an Additional Insured on this policy under: a.A written contract or agreement;and b.Where a certificate of insurance showing that person or organization as an additional insured has been issued c.When the written contract or agreement and certificate of insurance are currently in effect or becoming in effect during the term of the policy and executed prior to the"bodily injury,""property damage,"or"personal and advertising injury." 2.The insurance provided to the Additional Insured is limited as follows: a.The Additional Insured is only an additional insured for: (1)"Bodily injury,""property damage,"or"personal and advertising injury"caused in whole or in part by negligent acts or omissions of the Named Insured or anyone directly or indirectly employed by the Named Insured or for whose acts a Named Insured may be liable. (2)Liability arising out of your ongoing operations for the Additional Insured by or for you.A person's or organization's status as an insured under this coverage ends when your operations for that insured are completed. b.The Limits of Insurance applicable to the Additional Insured are those specified in the written contract or agreement but not more than the Limits of Insurance specified in the Declarations for this policy.The Limits of Insurance applicable to the Additional Insured are inclusive of and not in addition to the Limits of Insurance shown in the Declarations for the Named Insured. 3. In addition to the other exclusions applicable to Section I,Coverages A., B.and C.of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM,the insurance provided to the Additional Insured does not apply to: a."Property damage"to: (1)Property owned, used,occupied by, loaned or rented to the Additional Insured; (2)Property in the care,custody or control of the Additional Insured or over which the Additional Insured are for any purpose exercising physical control;or (3)"Your work"performed for the Additional Insured. b."Bodily injury,""property damage,"or"personal and advertising injury"arising out of an architect's,engineer's or surveyor's rendering or failure to render any professional services for you,for the Additional Insured or for others, including, but not limited to: (1)The preparing, approving or failure to prepare or approve maps,drawings,opinions, reports,surveys,change orders,designs or specifications;or (2)Supervisory, inspection or engineering services. c."Bodily injury"or"property damage"occurring after: (1)All work,including materials, parts or equipment furnished in connection with such work,on the project(other than service, maintenance or repairs)to be performed by or on behalf of the additional insured at the site of the covered operations has been completed;or (2)That portion of"your work"out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. 4.SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, Paragraph 4.Other Insurance, is amended to add the following subparagraph: d.Additional Insured's Other Insurance As Excess Insurance To the extent required by an"insured contract,"this insurance is primary on behalf of the Additional Insured;and any other insurance maintained by the Additional Insured is excess and not contributory with this insurance. If the "insured contract"does not require this provision,then Paragraph a.above will apply. B.Mobile Equipment Broadened Coverage V.12.f.(1)of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM is replaced by the following: (1)Equipment designed primarily for: (a)Snow Removal; (b)Road maintenance,but not construction or resurfacing;or (c)Street cleaning. Except the above provisions do not apply to self-propelled vehicles of less than 1,000 pounds gross vehicle weight which are not intended for use on a highway. C.Aggregate Limit Per Project MP 97 67 10 10 Includes copyrighted material of Insurance Services Office,Inc.and Page 1 of 2 American Association of Insurance Services,Inc.,with their permission The General Aggregate Limit under SECTION III—LIMITS OF INSURANCE of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM applies separately to each of your projects away from premises owned by or rented to you. Page 22 of 25 Includes copyrighted material of Insurance Services Office, Inc.and MP 97 67 10 10 American Association of Insurance Services, Inc.,with their permission D. Blanket Waiver Of Transfer Of Rights Of Recovery Against Others To Us The Transfer Of Rights Of Recovery Against Others To Us Condition(SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS)is amended by the addition of the following: We waive any right of recovery we may have against any person or organization to whom you by written contract or written agreement have waived your own right or recovery for loss caused by 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 written contract or written agreement with that person or organization and included in the"products-completed operations hazard." This provision does not apply unless the written contract or written agreement has been executed prior to the "occurrence"or offense giving rise to the"bodily injury"or"property damage." E.Voluntary Property Damage Coverage 1.We will,at your request,pay but not defend any claim for"property damage"to the property of others otherwise excluded under A.2.j.(4), (5)and(6)of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM provided that: a. Such"property damage"takes place while such property is in your care,custody or control, or is property of others over which you,for any purpose,are exercising or have exercised physical control;and b. Such"property damage"takes place away from any premises you own, rent or lease;and c. Such"property damage"takes place within the"coverage territory"and during the policy term;and d.Such"property damage"takes place only during your operations that are known to us,are scheduled on the policy and for which a premium has been charged. 2.The insurance under this additional coverage does not apply to"property damage"to property: a. Held by you for servicing, repair,storage or sale at premises owned by, rented or leased to you; b.While being transported by or caused by the ownership, maintenance,operation, use,"loading or unloading"of any "auto,"watercraft or aircraft;or c. Owned or occupied by or rented to you. 3. Deductible This additional coverage will apply only to that amount of any loss in each"occurrence"that exceeds $500.The terms of the policy with respect to your duties in the event of"occurrence,"claim or"suit"and the Company's right to investigate, negotiate and settle any claim or"suit"apply irrespective of the application of the deductible amount of$500. We may pay any part or all of the deductible amount of$500 to effect settlement of any claim or"suit."Upon notification of the action taken,you must promptly reimburse us for such part of the deductible amount as has been paid by us. 4. Limits of Liability The Limit of Liability for this additional coverage shall not exceed$2,500 for each"occurrence"and is the limit of the Company's liability for all damages on account of each claim or"suit"covered herein.The annual aggregate Limit of Liability is$2,500 and is,subject to the above provisions respecting each claim,the total limit of the Company's liability for all damages. 5. Settlement In the event of loss covered by this additional coverage,you shall, if requested by us, replace the property or furnish the labor and materials necessary for repairs thereto at actual cost to you,excluding prospective profit or overhead charges of any nature.Any property so paid for or replaced shall, at our option, become the property of the Company. Payment hereunder shall not constitute an admission of liability of you or,except as stated herein,of the Company. MP 97 67 10 10 Includes copyrighted material of Insurance Services Office,Inc.and Page 2 of 2 American Association of Insurance Services,Inc.,with their permission