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HomeMy WebLinkAboutInsurance Certificate: LTM, Inc A�RoDATE(MMIDDIYYYY) ® CERTIFICATE OF LIABILITY INSURANCE 12/2312022 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 Marsh I U.S.Operations Marsh USA Inc. 333 South 7th Street,Suite 1400 INCNr o.Ext): 866-966-4664 FAX No): 212-948-5382 Minneapolis,MN 55402-2400 E-MAIL SS: MDU.CertRequest@marsh.com Attn:MDU.CertRequest@marsh.cam;Fax:(212)948-5382 INSURER(S)AFFORDING COVERAGE NAIC# CN102299309-LTMM-GAWX-23-24 INSURER A:Liberty Mutual Fire Ins Co - 23035 INSUREDLTM,Incorporated INSURER B:N/A N/A dba Knife River Materials INSURER C:Liberty Insurance Corporation 42404 PO Box 1145 INSURER D: Medford,OR 97501 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: CHI-010199012-02 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR ,INSD,WVD, POLICY NUMBER (MM/DD!YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY TB2-641-445905-323 01/01/2023 01/01/2024 EACH OCCURRENCE $ 2,000,000 DGE TO RENTED CLAIMS-MADE X OCCUR PREM SES(Ea occurrence) $ 1,000,000 MED EXP(Any one person) _ $ 10,000 PERSONAL 8 ADV INJURY $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY X JECT LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: $ A AUTOMOBILE LIABILITY Al2-641-005097-05301101/2023 01/01/2024COMBINED SINGLE LIMIT $ 2,000,000 , (Ea accident) _ _ X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ X HIRED x NON-OWNED I PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) $ UMBRELLA UAB _ OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE • AGGREGATE $ DED RETENTION$ $ C WORKERS COMPENSATION WA7-64D-005097-023(Regulated) 01/01/2023 01/01/2024 X PER OTH- ERAND EMPLOYERS'LIABILITY STATUTE C nY/N WA7-64D-005097-013(AOS) 01/01/2023 01/01/2024 E.L.EACH ACCIDENT $ ANYPROPRIETOR/PARTNER/EXECUTIVE l l N/A 1,000,000 OFFICER/MEMBER EXCLUDED? "Stop-Gap""oLo (Mandatory in NH) "Ip p° E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Re:KRM Job#:16221126 CoA AMA Taxiway Reconstruct&Rehab. The City of Ashland,its agents,officers and employees is/are included as additional insured under general liability 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. Auto Liability: Primary and Non-contributory applies to our insured's owned autos subject to the terms&conditions of policy form CA 2048. Primary and Non-Contributory applies for General Liability per CG 20 01 attached. CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 East Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Ashland,OR 97520 ' ACCORDANCE WITH THE POLICY PROVISIONS. 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 0001110 SP 0524 -C01-P01110-I City of Ashland 20 East Main Street Ashland, OR 97520 11112.1.00524.01-00-0001110-0001-0007648 Policy Number: AI2-641-005097-053 Issued By: Liberty Mutual Fire Insurance Co. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE.OF CANCELLATION TO THIRD PARTIES This endorsement 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 LIABILITY 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 schedule on file with the Per schedule of certificate holders 90 Company on file with the company 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 above, We will send notice to the email or mailing address listed above at least 10 days, or the number of days listed above, if any,. before the cancellation becomes effective. In no event does the riptice,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 ceurtesy only.. Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the.policy. All other terms and conditions of this policy remain,unchanged. LIM 99 91 05 11 2011, Liberty Mutual Group of Companies. All rights reserved., Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc, with its permission. POLICY NUMBER:Al2-641-005097-053 'COMMERCIAL AUTO CA2048 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, DESIGNATED INSURED FOR COVERED AUTOS LIABILITY 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,, theprovisions of the Coverage Form,apply unless modified by the endorsement. This endorsement identifies person(s)or organization(s)who are"insureds"for Covered Autos Liability Coverage ' under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. SCHEDULE Name Of Person(s) Or Organization(s): Any person or organization whom you have agreed in writing to add as an additional insured,but only to coverage 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 primary and non-contributory to any like insurance available to the person or organization noted above. Information required to complete this Schedule, ifnot shown above, will be shown in the Declarations.- Each person or organization shown in the Schedule is an"insured"for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an"insured"under the Who Is An Insured provision contained in Paragraph Al. of Section II - Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2.of Section I - Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 0524.01-00-0001110.0002-0007649 �` POLICY NUMBER:TB2-641445905-323 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 A. Section II — Who Is An Insured is amended to 1. All work, including materials, parts or include as an additional insured the person(s) or • equipment 'furnished in connection with such organization(s) shown in the Schedule, but onlywith work, on the project (other than service, respect to liability for "bodily injury",• "property maintenance_'or repairs) to be performed by or damage" or "personal and advertising injury' 'on behalf of the additional insured(s) 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 omissions of those acting on your 2. 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 organization • in the performance of your ongoing operations for other than another contractor or subcontractor the additional insured(s) at the location(s) engaged in performing operations for a designated above. principal as a part of the same project. However: 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 permitted by Section III—Limits Of Insurance: law;and If coverage provided to the additional insured is 2. If coverage provided to the additional insured is required by a contract or agreement, the most 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 amount of insurance; not be broader than that which you 'are required 1. Required by the contract or agreement; or by the contract or agreement to provide for such additional insured. 2. Available under the applicable limits of insurance; B. With respect to the insurance afforded to these additional insureds, the following additional whichever is less. - exclusions apply: - - • This endorsement shall not increase the This insurance does not apply to "bodily injury" or applicable limits of insurance. "property damage"occurring after: Schedule Name Of Additional Insured Person(s) Location(s)Of Covered Operations Or Organization(s): Any person or organization with whom you have agreed in All locations as required by a written contract or wilting in a contract or agreement prior to an"occurrence"or' agreement entered into prior to an"occurrence"or "offense",that such person or organization be added as an offense. additional insured,on your policy Information required to complete this Schedule, if not shown above,will be shown in the Declarations. CG 20 10 12 19 © Insurance Services Office, Inc.,2018 Page 1 of -41.- 41% 1'7 0524-01-00-0001110-0003-0007650 POLICY NUMBER:TB2-641-445905-323 MERCJAL GENERAL.LIABILITY CG2O.37 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEAS E READ IT CAREFULLY. ADDITIONAL. INSURED OWNERS, LESSEES OR CONTRACTORS COMPLETED OPERATIONS . This endorsement modifies insurance provided underthe following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART A. Section 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, thefollowing 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, 1:6( - required by a contract or agreement the most.We "your work" at the location designated and will pay onbehalf• 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 irlsurance; insured only applies to the extent permitted by whichever is less. law;and This endorsement shall pot increase the applicable 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(s) Or Organization(s): Location And,Description Of Completed Operations Any Person or organization with whom you have agreed n All locationsas required by a written contract or writing in a contract or agreement prior to an"occurrence" agreement entered into prior to an"occurrence" or or"offense",that such person or organization be added as offense an additional Insured on your policy. Information required to complete this Schedule,if not shown above;will be shown in the Declarations, CS 20 37 12 19 0.Insurance Services Office.Inc.,2018 Page 1 of 1 Policy Number TB2-641-445905-323 Issued by Liberty Mutual Fire Insurance Co. THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO THIRD PARTIES This endorsement 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 LIABILITY COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY 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 sendnotice to the email or mailing address listed above at least 10 days, or the number of days listed above, if any, before the 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. All other terms and conditions of this policy remain unchanged. Schedule Name of Other Person(s)I Email Address or mailing address: Number Days Notice: Organization(s): Per Schedule on file with the Company Per Schedule on file with the company 90 " • LIM 99 01 05 11 0 2011, Liberty Mutual Group of Companies. All rights reserved. Page 1- of 1 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. 0524-01-00-0001110-0004-0007651 NOTICE OF 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 10 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 of Other Person(s) Email Address or mailing address:' Number Days Notice: Organization(s): • Per Schedule on file with the Per Schedule on file with the 90 •• Company Company All other terms and conditions of this policy remain,unchanged. Issued by Liberty insurance Corporation 21814 For attachment to Policy No.WA7-84D-005097-013 Effective Date Premium$ Issued to Centennial Energy Holdings,Inc. Endorsement No.. WC 99 20 75 @2016 Liberty Mutual Insurance Page 1 of 1 Ed.12/01/2016 NOTICE OF CANCELLATION TO THIRD PARTIES A. if we cancel this policy for any reasonother 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 10 days, or the number of days listed below, if any, before cancellationbecomes effective. In no event does the notice to the third party exceed the notice to the first named insured. B. Thisadvance 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 of Other Person(s)/ Email Address or mailing address: Number.Days Notice: Organization(s): Per schedule on file"with the Per schedule on file with the - 90 Company Company . Ali other terms and conditions of this policy remain unchanged. Issued by Liberty Insurance Corporation 21814 For attachment.to Policy No.W.A7-64D-005097-023 Effective Date Premium$ Issued to MDU Resources Group, Inc. Endorsement No. WC 99 20 75 O 2016 Liberty Mutual Insurance Page 1 of Ed. 12101/2416 0524-01-00-0001110-0005-0007652