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HomeMy WebLinkAboutInsurance Certificate: Northwest Raw LLC AccoRD® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYI() 4/8/2021 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 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: Terry Friend Protectors Insurance, LLC PHONE FAX P.O. Box 4669 tA/CC,No,EA); 541-842-2958 (A/C.NO:541-772-1906 Medford OR 97504 E-MAIL i Ess: terryf@protectorsins.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Ohio Security Insurance 24082 INSURED NORTH04 INSURER B: - Northwest Raw LLC 370 E Main St INSURER C: Ashland OR 97520 INSURER D: INSURER E: INSURER F: COVERAGES_ _ CERTIFICATE NUMBER:411864658 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 INSR WVD POLICY NUMBER (MMIDDIYYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY BZS57238502 5/8/2021 5/8/2022 EACH OCCURRENCE $2,000,000 AGE TO CLAIMS-MADE X OCCUR PREM SES(EaENTED occurrence) $2,000,000 MED EXP(Any one person) $15,000 PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 PRO POLICY X JECT LOC PRODUCTS-COMP/OP AGG $4,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS BODILY INJURY(Per accident) $ AUTOS NO OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ _ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVEN A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF ERATIONS below E.L.DISEASE-POLICY LIMIT, $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Certificate holder is listed as additional insured per BP7996 0916 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 St Ashland OR 97520 AUTHO IZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD BUSINESS:OWNERS 6619,16, T111$ ENDORSEMENT 01.1.4.40$1100:0:044,PLEASE REAP IT0A-0:004)" BUSINESS:OWNERS LIABILITY:EXTENSION 'ENOORSEM.ENT' This'.'ehdprserharit mods, :0%)00Pe provide ;ktnctOr. BUSINESSOWNERS COVERAPORIVr OeigYY summarization 4*: coverages Pr.010.P4 *1(1,*'00P.Mf• No cQverag ar ttiwry by 'summary. Actual ,:osfor,-449 :40P00.400,P 'Ore 0,040(8.010001,, SECTION SUBJECT A. Supplementary, Payments, - - • • bail',tOnds Loss Of Earnings. B. ;BrOadeffed, COVerag4 fobt,Damage. TO;PfeThiSe.P Rented 'T:t0e014 C. 'Incidental 'Medical 'Malpractice. 0115i-flOtit E. ;Blankot:,AdditiOnaf Insured C'dfitrableifs F. ‘,Newly Formed' Or Acquired. Organizations A04176010 Limits Duties 16 The Event Of OCCUIrOtte,;. OffebSe; !Claiiti Of Suit I. -Liability, And' Medical' Expenses 'definitions 0040 [0.11-0- 104ir,ed Contract Pérsohàl 'And -Section. II LiabilIty, is:amended avfollows:: .Supplementary Payments Section Act...00sinesciloteility 1§T000.iff00 !,01010v.tik: I The $250 limit shown in Paragraph A.14.(10), 00640'Eiden***- Supplementary Payments for the cost :bonds, is'replaced ,by':a.$1;0661imiC 2 The $250 limit 4ilowiT, in Paragraph; .Coverage s, Extension Supplementary Payments or reasonable ;e)coorie$ and.iloss, earnings is roplogod fiy10.$00,:ftrolt, B. Broadened'c:09;eit'Sgk FP:fpaibi'age preffitSWRO0t0 To Yu' 1. The:last paragraph .Of Section r Exclusions Tw,Applicable To Business Liability Coverage I's replaced by With respect to the premises whichare rented to you or temporarily occupied iiStlyPP With ih910,0701P- 8.:1010 :Prvwconor„ E.,X010100§ 014 n;004 001 apply toHproperty -.0.„000`9.0", .2,1P.15(011Y,ZMI44:012.168*-raj1i4,6 12313,19 96 0010 inciurtescopyridled-rnaterfal OfInSuranpeservicesQuipQ;Inc with jtsperrnission. Page 1 tit 4. Paragraph:01. Liability And Medical Eipenseelirnitsiarlbeurance Is,replaced 4y4thaJcillovvinTi The most we i pay under this endorsement for the"sum of all damages because of all FJProperty". damage to premises while ;-rented to you or temporarily ,:occupied by you On the permission of,to 04-0et. ikilrip tog tne PabteratiOr% ParegraPh D.3 Llãliilty And MatiliCal hot wofyl C. incidental Medical Malpractice Injury Paragraph under :Paragraph :,001tstons -1*p.offoAlitkto-Otojoro§§(0001)4y.Coverage :s100:01$or8;:too-sdop not APi 'to:'frtol4grfigt ML ! .1iMAlotrootfoo ctniors'4' 2; With feetie:a To this,fer..1400014,etit, f0110WrIgis added jo Sbbtibri F. LlatillUty!AfritVIVIOWal: Expenses a.. 'Incidental:- Medical. Malpractice Injury" means bodily injury arising :out of the rendering of or failure to to, render,:"during the p-ojfpy. period, the following :setylp,p5 ,M041,4.al, 84r4y ALItog:, $06#00., 6r,treatment or the ithingØf furnishing :Op:0. or iwoog,00. 16. :00400004 ttiorAWitft The furnishing or aspensino, of drugs or medical, dental; or surgical :supplies: or appliances. coverage does not apply tc:.1 =,! 10110.7000'": by the insured for titstiolo' to rotor's at the time of an accident ,go:4'the Ntios I thé EVObt bI 00oottomoi .:Ottonso, Orow:>orSfit Condition if§amended AP40toinal.s? py My triSared01-06146.6`;in'the l business or OCOUpatiOff of providing any of two,servicestuewitieti under.a. above. • Injury caused by any indemnitee if such indemnitee ;is onoogo0 in the:0'44gsA or occupation Ot;otoOltig; of the soriogs 400,011100 tfottor Ai A** D. Mobile Equipment Section t. Who. Is An Insured amended ito: include, any person- .driVing mobile equipment ' with your permission; Blanket *0000 Insured (Owners, Contractors Or Lessors) Section V114I An:1111401*0 is Vidttd01 0,14040 gtb 1ri$4(04., kV)PIiiProtoruglioil venom you ate-requited to name as an additional ;inSUrari on this policy under a written contract or written egreement. The written contract or agreement -must be: Current ihaffect or becoming" effecilm during the.term-Of'this b•olloy.., •and b. (?C0cY.t9,4 PO:Or icAh9:"pØ61' 1njry ''-:or000ttY Ogologgtor ' ,trigi and,AOOrtfs)b.g 'The rrf.§10fOltice;'l.Off.04:00 WOO, oe:fplipw-et, a. The person or orgeniiation• is only eh:additional ins.ured "with respect Ctoiliability, oUt:Of:, (4. Rear property as described ine,vriffen contract or written agreement, :you own, rent, lease, :.r.n2qjrt,fri. or ocovo ;: andt Caused in WJ1oe or part wiyogir OttiOitfa 40040.40:: performed for that insurpd b The Limit Of IfieUratiee. atitilidefile.: ;16:Ithe“additlOrial insured are those specified in the written contract or'written agreement or;the available under this palicx„ as,stated in the tieclara,. tibnsi,'Whidhever •artilese.These:limits are inclusive &and in addition' to the Limit:Of'insurance! averiable under'this;vpli.pyi 'Thel 104(000.:_.01.0:(10,0 to:MO#(1011100.1, 4.00:: not Atvly? (i Liäbilit/ eriaing ,ALVOrthe:SOle ffig,ItgeriCe Of,the edditiPtial: AffStired:l (2)" "Bodily; injury) '-!property damage', ".personar and advertising injury',, or .defenser fcoverege under the '$•qP149.01,*.grr Pyrnents section Pf the policy arising out of an architect's, on- i)Jingges, or gMrYPY,Pr10 rendering failure to roMor,00Y L.Ports%Nicitof,:strA§:0_‘:f.Ap,00 _ BP,19 90 09';f6l jneiude :APPyitlitP0-meteriel ottnanpg.sprv.ices:mogdne.,:voltWit$?:perriiission. Page 2 04.. _ .The;preparipg, or approving of maps, ,shop draWings, opinions„ reports, surveys,- field- - 'orders, change'orders, or drawings, and sp.eeifiCations; and (b) Supervisory, inspection, architectural or.ertgineehrig activities 13 ' Any7004-,1(f000,0" that takes place Off0f. ig'1.0.(100f: in 140 c;frOrt1i$10- OSOti0,60 ih Ahe-..Doeieratiot or! 141 igtruetural alterations, new construction or demolition operations performed by or for the person :or organitationdesignated Inthe Declarations., 3 ,Any coverage 'prosildo hereunder shall be excess over ny other valid and collectible 10s4r000g, avail- able to the OOditiO04! insured1 whether primary, excess, contingent or on any other basis unless contract specifically requires that this insurance be request that it apply on a'0fretiaty: F. Newly Formed:Or Acquired brgprazaifons, The following is added to Section ',!$:„An insured acquired :iriolOrp.OtalOtt OrAorgAINZPO: 0040 the of Of!'o:fly.: State Of the United States of America over which 'you maintain majority ownership interest exceeding fifty' percent- SItcnacqUired or newly formed organization `Wilt O.ualifY -aseAS.lamed...Inured ilfthere is,no,siinilar insurance avertable to that entity. 'However Coverage under this prpvision is afforded only until the 1Oth day after the entity wa acquired or ih..OrD,Of010- Org:OrtizOl. :011-10.4tid Vf :OWN; whichever eafiler, ,gettiOn A.I. üsIñsLiábility .d,bes no aPPlYito: "Bodily or'"property- damage"' that occurred before the entity was acquired orincorporated. OrgAr.#94 •@r).0: ,riro "P.O.:0401 000 i.4,0011$1.60 191rY."' gomog; :OA of At offense before lhOrOhlify' qUire.dDriritOrprifated oorganized OY`:yOcr. 3. Record's,and descriptions: totoperetions; must. be maintained: by,thetirst Named Insured. No person or organization isan insured with respect':to:the conduct of any current' or past partnership; joint venture or.limited liability .company that is not shown as a Named Insured in the Opelato(ops,, G..: Aggregate 1.,101,4 The ifolioWiho is added Paragraph Aggregate Lirn It Liabilit . and Medical; :PPertSeS LiMitS. Insurance: The :Aggregate Limits apply PP4r4tPly. tO each of the "locations'' owned by or rented to you or temporarily occupied by you with the permission of the owner • • Z... The.Kggregete aPPIV -SeParatellY' to 00) of, djir. IstO100t$ frOfil OwtiOctby:Or rented'to yoU For the purpose of this endorsement only, "location" means premises involving the same:or.conne.ct . ing lots, or premises whose conpeOtiOn is interrupted only by a street roadway, waterway or ridr* Pf=11.1/.4Y.', H. rgttleS: In The EVeill Of go.aiitiekee; OffeSe§ei-C10.101"Or Suit 1. Paragraph E.2.a. 1:).'utles, lir The Event'„0,f,'Occurrence, 'Offense, Otalm Or :Sult Liability And Medical Expenses General Condition applies •only whenthe o"occurrence"' IS known to any:insured listed in Paragraph C I Who Is An insured or:OriY. "employee"' 006000 :0y. you to give' receive :notice of;an "i000qrrehoe!" or claim. .z perebreoh, TAAtie,S Slrf The Event Of (Thourren0:e, OffenSe, ;claim Or Suit Medital EXperiSeS General Condition betOriSidered breaChed urileSS the breaCn occurs after StiCh or "suit" is known to.any insured listed under ,Paregrapnt:A-..11Vho IsAn Insured or any 'employee" authorized by you 10,,,,give :or receive, notice;:of an'"occurrence,' ;or Claim. Liberty? BP 79 96 09' Includescopyrightedmatedel efInsurance8ervi0.es:OffiC%,111P-Afith4t$;periTiissiOn. Page :3 of Section F....Llabllity And Medical Expenses befinitions Js modified 1. Paragraph F.3. islefilaced by,the W)libwirtg: '1;•• '41640Y, :Th11-1.e means bodily injury, sickness, disease, hp.f461141 medical, :04(14.14p,f(01-% injury sutarned by a person, and :1001006.§ mental anguish resulting from any of these, 464 16040114 ,death r'671.11tirig: from an ,:otth-6.§6 at ah1Mel Paragraph F. . isreFilaced .by the ThIlOwihg; ,00.00.0t fo.r.'4,14044: of premises 11000:17; that portion f the contract for alease of ises that in1ernnifies' 4.17.1Y 0:0tWi Otkolpatiit-4-ffiri for damage by fire to, premises while rented to; tfy? yoti with permissionl of the owner' not ,an "insured :contract"; sidetrack agreement,i Pi' Limy',o8o01.01)t. PT 4grOrtiOni, cePt ir0000000(1 It Pti§.1411.911 = PlOr4.tiPt):$', 04 Or Witt)iff of, rAii(00. 4. An •obligatibr4 as,required by. ordinance-1 to indemnify .a•muniCioality, •.except. in connection; • with•work ;for a municiPality, gr . tor: Iratce garg-0.1tIRP.t rf...1 That:OM PfAtlYPitfOr',.(41.1(04.,. or kgrOtrii.O.Of ni 1Øyoso, 0004000 Of a municipality in connection with work performed which you assume ithe-foreliahility ,of another party to pay for "bodily injury", or "property .damagal! , AO „a;third person or organization, provided -the injury" or "'property damage!' • caused, .,..vs,6419. or,in part, by you or -by those acting on your behaif Hovv4ygrk. S„c10,t! of OPtiffr..40.: 'Pr agreement shall only be '0,00104t9::.4 "insured' 'contract" to the 0).00.1 your assumption of the tort liability is permitted oy,10,:., Tort liability means *li4oiliv that would be in the abSehee.Otarly COritraCt ofkagrietheht, :ParagraPIT t.does not include.-that part ofany:contract oreweement: • (1) That, indemnities a railroad for "bodilyinjury" or "property damage" ajising out Ot tfr401001, or demolition PPOr43r.PrIgi within 50 feet of any railroad property nd affecting 4-11yt,..70iitogo: 0'00,Offro.$tx tracks ,t0.6070.04§, tOrte.1, :Oride,h)0$ r0f0S$.16% 421 That indemnifies surveyor for injury On damage::arising out of ,Preparih91 a.,approvirq,,, :or failing to:prepare--or approve: maps, shov&awihge, opihF, ions, reports, surveys,- change orders or drawings' aDd,specifications,7, . . or (b) directions r_orifotrottioo$„ or failing to tistoltArkitthatl$the orifii4rY' 0:40$0 Of agolool ulder, which] the insured, It an, architect, engineer or tsurveyor, assumes; liability for an jrijury, or damage (arising 'T‘oLiti ofthe insureers wendating„or failure.•to: render',protesaionaf le,ffyloesdhOlpOihg those listed 4PpY,o, and supervisory, inspection, architectural or Paragraph F:14.14.• Personal AndAdvertising 'WNW'We01000dW11-3.0 followingt I Nialialbus ;prosecution, or abuse•Otpro.cess; BP•19 06 09.1.6i inciude$Aopyrightedmatarial ainsuronce6oryjoesOfice;Inp„Withitsi)ermls$ion.. 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