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HomeMy WebLinkAboutInsurance Certificate: F.D. Thomas Inc (2) Ac v® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 5/24/2022 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 the policy, certain policies may require an endorsement. _A statement on this certificate does not confer rights to the certificate holderin lieu of such endorsement(s). PRODUCER CONTACT Alliant Insurance Services Houston, LLC • • PHONE FAX, •5444 Westheimer RD 9th fl . (AIC,No,Ext): (832)485-4000 (NC,No):(832)485-4001 ' Houston TX-77056 . X 77056ADDRESS: arctic.certs@alliant.com • __INSURER(S)AFFORDING COVERAGE NAIC# ' License:0C36861 INSURER A:Tokio Marine Specialty Insuran 23850 INSURED ARTCSLO-01 INSURER B:Everest National Insurance Corn 10120 F.D.Thomas, Inc. 217 Bateman Dr • INSURER C.:American International Group U 19402 Central Point, OR 97502 INSURER D:• INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1556613750 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 SUBR - POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD • POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) LIMITS B X COMMERCIAL GENERAL LIABILITY Y EN6GL00162-221 6/1/2022 6/1/2023 EACH OCCURRENCE $3,000,000 CLAIMS-MADE' X OCCUR PREMISES Ea occur ante) $100,000 MED EXP(Any one person) $10,000 - PERSONAL&ADV INJURY $3,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $6,000,000 POLICY X 128., ' LOC ' PRODUCTS-COMP/OP AGG $6,000,000 OTHER: $ B AUTOMOBILE LIABILITY EN6CA00287-221 6/1/2022 6/1/2023 COMBINEDaat SINGLE LIMIT $5,000;000 (E =Wen) X ANY AUTO - BODILY INJURY(Per person) $ • OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY. - (Per accident) • Comp/Coll Ded $.1;000 C X UMBRELLA LIAB X 'OCCUR 62785812 6/1/2022 . ' 6/1/2023 EACH OCCURRENCE: $10,000,000 ' EXCESS LIAB CLAIMS-MADE • ' AGGREGATE $10,000,000 DED RETENTION$ •_' $ • B WORKERS COMPENSATION EN6WC00185-221 '6/1/2022 6/1/2023 X STATUTE ERH • B AND EMPLOYERS'LIABILITY Y/N EN6EW00002-221 6/1/2022 . 6/1/2023 B ANYPROPRIETOR/PARTNER/EXECUTIVE EN6WC00186-221 6/1/2022 - 6/1/2023 E.L.EACH ACCIDENT • $2,000,000 ' ' B OFFICER/MEMBEREXCLUDED? ' N NIA EN6WC00187-221 6/1/2022 6/1/2023 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $2,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $2,000,000 A Contractors Pollution Liability ' PPK2416741 6/1/2022 6/1/2023 Per Incident $5,000,000 Aggregate Limit ' $5,000,000 • DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required): ' - • • • • • See Attached... ' CERTIFICATE HOLDER CANCELLATION ' ' • . SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE' THEREOF, NOTICE .WILL BE DELIVERED IN . ACCORDANCE WITH THE POLICY PROVISIONS. ' . City of Ashland ' 20 E. Main Street 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 • AGENCY CUSTOMER ID: ARTCSLO-01 LOC#: • ACORE) ADDITIONAL REMARKS SCHEDULE Page 1 of AGENCY NAMED INSURED Alliant Insurance Services Houston,LLC F.D.Thomas, Inc. 217 Bateman Dr POLICY NUMBER Central.Point,OR 97502 CARRIER NAIC CODE EFFECTIVE DATE; ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE INSURER AFFORDING COVERAGE:Berkley Assurance Company - NAIC#:39462 POLICY NUMBER:PCAB50175430622 EFF DATE:06/01/2022 EXP DATE:06/01/2023 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Professional Liability Each Claim $5,000,000 Aggregate Limit $5,000,000 FDT Job Number:70862;FDT Job Name:City of Ashland-Effluent Launder Clarifier Coverage for Contractual Liability is provided under General Liability policy. The City of Ashland,Oregon,its officers,agents and employees are included as Additional Insuredsas respects to General Liability. General Liability policy shall be Primary to any other insurance in force for or which may be purchased by Additional Insureds.. • ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • POLICY NUMBER: EN6GL00162-221 COMMERCIAL GENERAL LIABILITY CG 20 37 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED- OWNERS, LESSEES'OR CONTRACTORS = COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Any person or organization whom you have agreed to All locations where you perform work for such additional include as an additional insured under a written insured pursuant to any such written contract contract, provided such contract was executed prior to the date of the loss Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Section II --Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III—Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage" caused, in whole or in part, by required by a contract or agreement, the most we your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance: performed for that additional insured and included in the"products-completed operations hazard". 1. Required by the contract or agreement; or However: 2. Available under the applicable limits of 1. The insurance afforded to such additional insurance; insured only applies to the extent permitted by whichever is less. law; and This endorsement shall not increase the 2. If coverage provided to the additional insured is applicable limits of insurance. required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 12 19 ©Insurance Services Office, Inc., 2018 Page 1 of 1 POLICY NUMBER: EN6GL00162-221 COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED.- OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations Any person or organization whom you have agreed to All locations where you are performing ongoing include as an additional insured under a written operations for such additional insured pursuant to any contract, provided such contract was executed prior to such written contract the date of the loss. Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect toliabilityfor "bodily injury", "property This insurance does not apply to "bodily injury" or damage or "personal and advertising injury "property damage" occurring after: caused, in whole or in part, by: 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 10 12 19 ©Insurance Services Office, Inc., 2018 Page 1 of 2 C. With respect to the insurance afforded to these 2. Available under the applicable limits of additional insureds, the following is added to insurance; Section III—Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable limits of insurance. will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 10 1219 POLICY NUMBER: EN6GL00162-221 COMMERCIAL GENERAL LIABILITY ECG 24 520 04 02 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT - OTHER INSURANCE (PRIMARY NONCONTRIBUTORY) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Paragraph a. Primary Insurance of 4. Other In- surance of SECTION IV COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced by the following: a. Primary Insurance This insurance is primary except when b. below applies. If this insurance is primary, our obliga- tions are not affected unless any of the other insurance is also primary. Then, we will share with all that other insurance by the method de- scribed in c. below, except that we will not seek contribution from any party with whom you have agreed in a written contract or agreement that this insurance will be primary and noncontribu- tory, if the written contract or agreement was made prior to the subject "occurrence" or of- fense. ECG 24 520 04 02 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 0 with its permission.