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HomeMy WebLinkAboutInsurance Certificate: Evergreen Job & Safety Training Inc CITY RECORDER ACC:30RE) DATE(MMIDD/YYYY)• CERTIFICATE OF LIABILITY INSURANCE 3/14/2022 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 thepolicy,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: Susan Bernosky Strahan Insurance Services Inc • (A(E�/C No,Ext): 5104509051 FAX No): 5940 College Ave Ste A ADDRESS: sbernosky@strahaninsurance.com INSURER(S)AFFORDING COVERAGE NAIC# Oakland CA 94618 INSURER A: Landmark American Insurance Company 33138 INSURED INSURER B Evergreen Job and Safety Training,Inc INSURER C: 1352 Palmerston Loop INSURER D: INSURER E: Roseville CA 95678 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 2 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 AWOL3UBR' POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) LIMITS K COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE K OCCUR PREMISES(Ea occur ence) $ 50,000 MED EXP(Any one person) $ 5,000 A Y Y LHC845567 03/14/2022 03/14/2023 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECT LOC PRODUCTS-COMP/OPAGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMNINEU SINGLE LIMI f $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED —NON-OWNED PROPER I Y DAMAGE AUTOS ONLY _AUTOS ONLY -- (Per accident) • $ UMBRELLA LIAB _OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ • DED RETENTION$ $ • WORKERS COMPENSATION - PER 01H- AND EMPLOYERS'LIABILITY- Y/N • STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT , $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ • If yes,describe under - -. DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Each Claim 1,000,000 A Professional Liability:Claims Made LHC845567 03/14/2022 03/14/2023 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) THIS CERTIFICATE SERVES AS PROOF OF COMBINED PROFESSIONAL AND GENERAL LIABILITY COVERAGE. • Additional Insured per RSG 55005 0710 Waiver of Subro per RSG 54078 0310 Primary and Noncontributory per RSG 54155 081.6 • 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. • 90 N.Mt.Avenue AUTHORIZED REPRESENTATIVE Ashland OR 97520 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD • • 4 • This Endorsement Changes The Policy. Please Read It Carefully, ADDITIONAL INSURED- . BLANKET • This endorsement modifies insurance provided under the following: • COMMERCIAL GENERAL LIABILITY COVERAGE FORM • SCHEDULE • Name of Person or Organization: Any person or organization to whom or to which you are obligated by virtue of a written contract or by the issuance or existence of a written permit,to provide insurance such as is afforded by this policy. A. SECTION AI - WHO IS AN INSURED .is amended to include as an additional insured the person(s) or organization(s) shown on the SCHEDULE, but only with respect to liability for "bodily injury", "property damage" or"personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. B. With respect to the insurance afforded to these additional insured, the following additional exclusions apply: This insurance does not apply to"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(s) at the location of the covered operations has been completed; or 2. That portion of"your work" out of which the injury or damage ariseshas 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. • • • • This endorsement effective • forms part of Policy Number issued to by • • Endorsement No.: RSG 55005 0710 Includes copyrighted,material of Insurance Services Office, Inc. with its permission. This Endorsement Changes The Policy. Please Read It Carefully. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE. CONDITION (SPECIFIC) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE • Name of Additional Insured •The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to the additional insured listed in the SCHEDULE above provided that: (1) The additional insured is a Named Insured under such other insurance;and (2) You have agreed in writing in a contract or agreement that this insurance would be primary•and would not seek contribution from any other insurance available to the additional insured. • • This endorsement effective forms part of Policy Number issued to • by Endorsement No.: RSG 54155 0816 Includes copyrighted material of Insurance Services Office, Inc. • with its permission. • • 4 This Endorsement Changes The Policy. Please Read It Carefully. WAIVER OF TRANSFER OF RIGHTS OF • • • RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: • • Any Person or Organization As Required By Written Contract The following is added to SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, 8. TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US: We waive any right of recovery we may have against the person or organization shown in the SCHEDULE above because of payment we make for injury or damage arising out of your ongoing operations, "your product" or "your work" done under a written contract with that person or organization and included in the "product-completed operations hazard". This waiver applies only to the person or organization shown in the SCHEDULE above. . • • • , • • • • • • • • • This endorsement effective Forms part of Policy Number Issued to v by • Endorsement No.: RSG 54078 0310 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Copyright, Insurance Services Office, Inc., 2009