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HomeMy WebLinkAboutInsurance Certificate: LTM Inc L12 345-5000 1Z/Z3/ZOZ2 4 : 59:17 PM PAGE 2/009 Fax Server DATE(MM/DD/YYYY) ACCORD CERTIFICATE OF LIABILITY INSURANCE `�- 12/232022 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 jOR 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 I coNTACT Marsh I U.S.0 erations Marsh USA Inc. I NAME: P • 333 South 7th Street;Suite 1400 • (A/C No.Ext): B66-966-4664 (A//� No): 212-948.5382 Minneapolis,MN 55402-2400 ADDleRss: MDU.CertRequest@marsh.com Attn:MDU.CertRequest@marsh.com;Fax:(212)948-5382 INSURER(S)AFFORDING COVERAGE NAIC# CN102299309-LTMM-GAWX-23-24 2010 2037 LTMME Al Y INSURER A:Liberty Mutual Fire Ins Co •_ 23035 INSURED • INSURER B:Associated Electric&Gas Ins Servce'siLtd 3190004 • LTM,Incorporated . - dba Knife River Materials - INSURER C:Liberty Insurance Corporation 42404 PO Box 1145 Medford,OR 97501 INSURER o- INSURER E: • INSURER F: COVERAGES CERTIFICATE NUMBER: CHI-007946941-30 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.LIM ITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. • INSR TYPE OF INSURANCE ADM SUER POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER (MMIOD/YYYY) (MNI/DDIYYYY) LINTS A X COMMERCIAL GENERALUABILITY 782.641-445905-323 01/01/2023 01/01/2024 EACH OCCURRENCE $ 2,000,000 AMAGE TO REND . CLAIMS-MADE X OCCUR, PREM SES Ea occurrence). $ . 1,000,000 • • MED EXP(Any one person) $ 10,000 PERSONALS ADV INJURY $ - 2,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: . GENERAL AGGREGATE $ 4,000,000 POLICY X JE LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: ` • • $. • A AUTOMOBILE LIABILITY Al2-641-005097-053 01/01/2023 01/01/2024 COMBINED SINGLE LIMIT $ 2,000,000 (Ea accident) X 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) .$ • B UMBRELLA LIAB _ OCCUR XL5063412P • 01/01/2023 01/012024 EACH OCCURRENCE $ 5,000,000 X EXCESS LIAR CLAIMS-MADE AGGREGATE $ 5,000,000 DED REI CNTION$ -• ' $ I C WORKERSCONPENSATION WA7-64D-005097-023(Regulated) 01/01/2023 01/012024 X PER DTH- AND EMPLOYERS'LIABILITY . STATUTE ER C Y/N WA7-64D-005097-013(AOS) 01/01/2023 01/01/2024 ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? n N/A EL EACH ACCIDENT $ 1,000,000 (Mandatory In NH) "Includes"Stop-Gap"" , E DISEASE-EA EMPLOYEE $ 1,000,000 lives describe under DESbRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 1,000,000 't . • DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Re:Al Operations - . • • City of Ashland is/are included as additional insured per the attached CG 2010 and CG 2037 endorsements and does not include professional liability coverage. Blanket Additional Insured for Automobile Liability is included per attached designated Insured Endorsement CA 2048. Excess liability apples to general lability,products and completed operations,automoble Bablity,and employers liability. • CERTIFICATE HOLDER CANCELLATION, • City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn:Kari Olsen THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 90 N.Mountain ACCORDANCE WITH THE POLICY PROVISIONS. Ashland,OR.97520 . .' AUTHORIZED REPRESENTATIVE . - of Marsh USA Inc • • ©1988.2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) • The ACORD name and logo are registered marks of ACORD' - . 212 345-5000 12/23/2022 4 : 59: 17 PM PAGE - 3/009 Fax Server • • • • POLICY NUMBER:A€2--6.1 i-0O5 ?-0:53 '. COMMERCIAL AUTO • CA.20 43 10 13 • THIS ENDORSEMENT CHANGES THE POLI,CY. PLEASE READ•fT CAREFULLY: DESIGNATED INSURED FOR COVERED AUTOS I L COVERAGE • This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM , BUSINESS AUTO COVERAGE FORM • • MOTOR CARRIER COVERAGE FORM • • With respect to coverage provided by this endorsement;the provisions of the Coverage Form apply wiless • modified by'the endorsement. • This errdcyrserne:nt identifies person(s}€yr organization(s)who are"insured, For Cove.red Autos Liabitity•Coverage under the Who is An Insured provision of the Coverage Fora This endorsement does nbt aitei coverage provided in the Coverage Form. • • • • SCHEDULE i Name Of Person(s)Cr Orgenizatiori(s); . • , Any person or organization whom you have agreed in writing to add as an additional insured, but,only to crauerage and minimum limits of, • insurance required by the written agreement, and in no event to exceed • either the-scope of coverage or the.limits of Insurance provided in this.policy. This policy will be prttnery and non-contributory to any like insurance • available to the person or organization noted.'above. • • • • Information required to ccrari{aiete this Schedule if not shoVni above, will be•shown in the C'eciarations. • Each person or organizatio t shown in the Sd hedule is. • en"Insured'far.Covered Autos Liao€i€tv Coverage., but only to the.extent that person ur'organization qualifie as an"insured"under the Who Is An tnsurr:d provision • contained in.Paragraph A.1.of Section H -".Cgyered,• - Autos Liability Coverage In the. Business Auto and • MotorCerrior Coverage Forms.and Paragraph D.2.of • Section I - Covered Autos Coverages of the Auto .Dealers Coverage Form. • • • • • CA Z:148 10 13 ©Ins:canoe•Services°f1iee,iinc., 2011 - Page 1 of 1 I 212 345-5000 12/23/2022 4 : 59:17 PM PAGE 4/009 Fax Server • • Polley Number:Al2.-r;;41• �J p•97 G53 • issued By: Libel:ty 1C1_:t.uel Fire insurance Co. • THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY: NOTICE OF CANCELLATION To THIRD PARTIES- This en>dorsement modifies insurance provided under the following:. • BUSINESS AUTO COVERAGE PART • .MOTOR CARRIER.COVERAGE PART • • GARAGE COVERAGE PART TRUCKERS COVERAGE PART • EXCESS AUTOMOBILE LIABILITY INDEMNITY COVERAGE PART SELF-INSURED TRUCKER EXCESS LIABILF I•.Y COVERAGE.PART COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS,LIABILITY COVERAGE PART • LIQUOR LIABILITY(COVERAGE PART • Schedule • Name of Other Person(s); Email Address or mailing • Number Organization(s).: • address: Days Notice: Per sC:;iaduie on rile with. ithe Per seh duce o c :5'ckfical.t a iiOl ers ao • • A. If we oi-Ancel this policy'fix any reason other than nonpayment of premium, we will notify the persons or organizations. shown in the Schedule above. We will send 'notice to the email or tnailing. address tested above at least 10 days, or the number of days listed above, if any, before the cancellation becomes effootive. In no event ci.oes the noticc.to the third party exceed Iha otice to the first earned insured. B. This advance notification of a pending canceallation of coverage is intended as a courtesy only. Our failure to prgvide such advance notification will not extend the policy cancellation date nor negate c;anceiiaticn of the poiicy. • All other terms and conditions of this policy remain unchanged, • • • LIM 99 01 0511 J 20.11, Liberty Mutual Group of Companies. AU rig3iits reserved. Page 1 of I Includes.copyrighted tma1erial of.137suran ce Services Office,.Inc, with its permission, . 212 345-5000 • 12/23/2022 4 : 59: 17 PM PAGE 5/009 Fax Server • • • POLICY NUMBER:TB2-E.41.1.4439053-323 . • COMMERCIAL GENERAL LIABILITY CG-20101219 THIS ENDORSEIVIENT.CHANOES THE POLICY. PLEASE READ.IT CAREFULLY. • ,ADDITIONAL INSURED - OWNERS, LESSEES OR. CONTRACTORS - SCHEDULED PERSON. OR • ORGANIZATION • This endorsement.modfies'insurance provided under•the:following: • COMMERCIAL GENERAL LIABILITY COVERAGE PART A..Section Il — Who Is An Insured is amended to 1,, All work, including mater al, parts #fir • • include as an additional insured the person(s) or egs.iipment furnished. in t.o: nection with such organizatibn(s) shown in the Schedule, but sadly with wrork, on the prc ect (other than service respect to liability for "bodily injury" "property maintenance or rgoeirs) to be performed by Or • damage" or "personal and advertising in;UnP on behalf of. the additiona€ insureds; -at the caused, in whole or in part,by: location of the covered operations has been • 1, Your acts or omissions;or completed;or • 2. The:acts or omissiont of those acting on 'your That .portion of "your work" out of which•the behalf; injury or damage arises has been put to its intended use by any person or organi`attion in the performance of your ongoing operations for othts' than.another contractor of sub.nntrar.tor the. additioi-ral ins;::re•r (s) •at the loc::ation(s) engaged fist lzeiformirfcl, 4 Fr<atic)its for .a deiztnatei above. principal as a.patt of the s.arne:project. However r: C. With respect to the insurance afforded to these 1. The insurance. afforded to such additional additional. insureds, the following is added to insured only applies to the extent treat}fitted by section ill•-Limits Of insurance; law: and • if coverage provided to thte additional insured is 2. if ciciareiage. provided to the additional insured :s req ired by a contract or agreement, the roost we . required by a contract or agreement, the will pay on behalf of the additional insured is the insurance afforded to such additional.insured will arnOii:nt Of insutLrOCe: not be broader than that which You are requireei� 1. Required by the contrai:t or.agreement or by the contract or .agreerra.4rst t�., provide for such additional insurel. 2. Available. under ' the aipplic:able limits 'of B: With respect to the 'insurance afforded to these iilSrarance: additional insureds, the. following additi4ral whichever is less:. exclusions apply: This endorsement shah not increase the • This. insurance does not apply to "bodily injury" or applicable limb or in urance, • "property damage"Osrcurrino after: • Schedule Name Of Additioenal insured Person(s) Location(s) Of Covered Operations Or Organization(s): .• Any person:or organization with whom you have agreed hi All lr cations a,rec;ir red by a written contract or . writing.n a contractor agrees enl, priorto an."occurrence or agre.eniehl:entered into prior to an'occ'ur'rence"C1r "offense",that'sudi person or organzatrcan be added as an offense, additional insured on your policy • . Information regii iced fo complete this Schedule..if not shown above, will•be shown in the CSeciaratinn.s. • CG 20 10 12 19 C Insurance Services Office, Inc.,,'2018 Page 1 of 1 • 212 345-5000 12/23/2022 4 : 59: 17 PM PAGE 6/009 Fax Server • • POLICY NUMBER:TB2-41.1-44 905.323 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. Thisendorselmen t i-nodifies insurance provided under-the fo<Iowini : • COMMERCIAL GENERAL LIABILITY COVERAGE PART • PRODUCTS/COMPLETED OPERATIONS LIABILi:TY COVERAGE PART • A. Section II Who I . An:Insured is amended to B; With respect to the ii $.13.4mfce afforded to the include as an additional..insured the persons} or • additional insureds, the following is added to rorciat*alion(s) she w' i the Schedule, hut. only Set fft—Limits Of Insurance: with .respect: to liability for "bodiiv injury' or if coverage provided to the. additional insured is. "prcipertyr damage" caused, in whole or in part. by • required by.a contract or agreement, the Most we • l'< i Atvork at the location designated and wiil ;aav on liehd F of tile additional' insured is the• described in the Schedule of this endorsement amount of insur-anCe: performed d for that additional insured and included in the*products-cornpletted operations.halard". Required by the contractor agreement:or However: 2, Available under the applicable limits. of • inSuri'inc; 1. The insurance afforded to such .additional insured only applies to the extent permitted by whichever r is less. • law: and , • • This-endorsement :hall not increase the applica.ale 2. If coverage 'provided.to.the additional insured Is • 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. • Schedule Name Of Additional Insured Person:(5) Or Organtaation(s): Location And Description Of Compfeted.•Operations • Any person orerganizelion with whom you have agreed in All locations as required by a written contract or writing in a Contiart or afire rient,•ptio<to.an "bccuit-erice" a0reennenrentered into prior to an":)ccurrerice" or or"offense",that such person or.orja7izetion beadded as offense. an additional insured on your poU y. • • Information required:to complete this Schedule:if not shown above,will be.thown in•the Declarations. • • • • L . • CG 20 37 12 19 P. Insurance Services Office, inc„2'01'8 Rage •1 of 1 Z1Z 345-5000 1Z/Z3/ZOZZ 4 : 59: 17 PM PAGE 7/009 Fax Server Policy Number TB2-541_445905-323 Issued by Liberty Mutual Fire Insurance Co. THtt a ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT' CAREFULLY. NOTICE OF CANCELLATION TO THIRD PARTIES • This endorsement modifie,s insurance provided under the fallowing: • • BUSINESS AUTO COVERAGE PART MOTOR CARRIER COVERAGE PART GARA(;aE COVERAGE PART TRUCKERS COVERAGE PART • EXCESS AUTOMOBILE LIABILITY INDEMNITY COVERAGE PART ELF--INSUREED TRUCKER EXCESS LIABILITY COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART' EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLET'EL OPERATIONS LlABILftY'COVERAGE PART ' LIQUOR LIABILITY COVERAGE'PART • ' COMMERCIAL LIABILITY- UMBRELLA COVERAGE FORM A.. If we cancel this policy for any reason other than nonpayment of premium, we: will notify the persons or • organizations shown in the Schedule of this endorsement, We will send notice to the email or mailing address listed above at least TO days, or the number of days €isted above. if any. before the cancellation .becoomes effec.tiv . in no event does the nogice to the third party exceed the notice. to the first named'insured. B. This.advance notification of a pendinsi cancellation of coverage is intended as a courtesy only. Our failure to provide such advance notification will not'extend the policy cancellation date nor negate cancellation of the i?olid,/. All ether terms and conditions of this policy re?Hain unchanged. Schedule Name of Other person(s)/ Email Address or mailing address: Number Days Notice: •Organization(sj:• Per Schedule o:,file with the Crrspany • Per Schedule en tie wUh Lir ccrnpany 8[i • • • t. .IM 99 01 05 11' C 2011•, Liberty Mutual Group of Cdrnpanies>. All rights'reserved. Page 1 of '+ IncluCles copyrighted material of InsUrance Services Office, Inc.,with itsp'ermi'5Sion. 212 345-5000 12/23/2022 4 : 59: 17 PM PAGE 8/009 Fax Server • • NOTICE OF CANCELLATION TO THIRD PARTIES • • A. If we cancel'this policy•for any reason'other than nonpayment'of premium, we will'notify thepersons or • organizations shown in the Schedule below.We will send nonce to the email Or mailing address listed below at least 10 days, or the number of days listed below, if any, before cancellation becomes effective..In'no event does the notice to the•third partyexceed the notice to the first named insured. B. This advance notification of pending cancellation'of coverage Is Intended es.a courtesy only. Our failure to provide such.advance notification will'not extend the policy cancellation date nor negate cancellation of the. policy: • Schedule Name of Other Person(s)I ' Email Address or mailing.address: Number Days Notice: Organlzation(s): Per Schedule on file with the Per Schedule on file with the •90 • Company Company • r • • • • • • - Ail otherterms and Conditions of thisp.ollcy remaln.urichaiiged. Issued by Liberty Iniuranci Corporation.21814 • For attachmentto Policy No,WA7-640-005097-013. Effective Date 'Premium$ issued to Centennial Energy Holdings, Inc.. Endorsement No. • WC 99 2075 • ®2016 Liberty Mutual insurance . Page 1 of 1 r • Ed.12/01/2016 • 212 345-5000 12/23/2022 4 : 59: 17 PM PAGE 9/009 Fax Server • • NOTICE OP CANCELLATION TO.THIRD PARTIES • A. if we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or organizations shown in the Schedule below.We will send notice to the email or mailing address listed below at least 1.0 days, or the number of days listed below, if any, before cancellation becomes effective. In no event does the notice to the third party exceed the notice to the first named insured. B. This advance notification of a pending cancellation of coverage is intended as a courtesy only. Our'failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy- • Schedule Name or Other Person(s)f Email Address or mailing address:. Number Days Notice: Organization(s): Per schedule on file with the • Per schedule do file with the 9Q Company Company • • • All other terms and conditions of this policy,'remain unchanged. • Issued by Liberty Insurance Corporation.21814 For attachment to Policy No,WA7-64D••O05097.023 Effective Date Premium$ Jssued to. MDU Resources Group, Inc. Endorsement N . • • WG.93 20 75 O 2.016 Liberty Miif ual Insurance Page I of 1 Ed. 1210112016 • • 212 345-5000 12/23/2022 4 : 59: 17 PM PAGE 1/009 Fax Server • • Facsimile Transmittal Sheet • MARS H An MMC Company From: Jesse Ortega To: ' • City.of Ashland Phone: Fax: 541-488-5320 Date: 23-Dec-22 Attention: Time: 03:58 PM Company: MDU Message: • •. • . • • The information contained in this facsimile message is confidential,maybe privileged,and is intended for the use of the individual or entity named above.If you, the reader of this message,are not the intended recipient,the agent,or employee responsible for delivering this information to the intended recipient,you are expressly prohibited from copying,disseminating,distributing,or in any other way using any of the information contained in this facsimile message.