HomeMy WebLinkAboutInsurance Certificate: Superior Fencing, LLC '4 t✓°® CERTIFICATE OF LIABILITY INSURANCE DA 32021
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
NAME: CLIENT CONTACT CENTER
FEDERATED MUTUAL INSURANCE COMPANY
HOME OFFICE:P.O.BOX 328 (o/CN No,Ext):888-333-4949 FAX
c. No):507-446-4664
OWATONNA,MN 55060 ADMDRESS:CLI ENTCONTACTCENTERI FEDINS.COM
INSURER(S)AFFORDING COVERAGE NAIC#
INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935
INSURED 378-466-7 INSURER B:FEDERATED SERVICE INSURANCE COMPANY 28304
SUPERIOR FENCING LLC INSURER C:
4843 TABLE ROCK RD
CENTRAL POINT,OR 97502-3155 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:12 REVISION NUMBER:0
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 QF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TR TYPE OF INSURANCE INSR 1NVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000
� DAMAGE TO RENTED $100,000
CLAIMS-MADE I"-I OCCUR PREMISES(Ea occurrence)
X BUSINESS OWNER'S LIABILITY MED EXP(Any one person)
A Y N 9283960 06/06/2021 06/06/2022 PERSONAL&ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
PRO-
�POLICY JECT I I LOC PRODUCTS-COMP/OP AGO $2,000,000
OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE UMIT $1,000,000
X ANY AUTO 1E8 accident)
_ BODILY INJURY(Per person)
B OWNED AUTOS ONLY AUTOSULED Y N 9283961 06/06/2021 06/06/2022 BODILY INJURY(Per accident
—
HIRED AUTOS ONLY NON-OWNED PROPERTY DAMAGE
AUTOS ONLY (Per accident)
-
X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $1,000,000
A EXCESS LIAB CLAIMS-MADE N N 9283962 06/06/2021 06/06/2022 AGGREGATE $1,000,000
DED I I RETENTION
WORKERS COMPENSATION PER STATUTE OER
AND EMPLOYERS'LIABILITY Y!N
ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? N I A
(Mandatory in NH) E.L DISEASE-EA EMPLOYEE
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addibonal Remarks Schedule,may be attached If more space is required)
THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED BY CONTRACT
ENDORSEMENT FOR BUSINESSOWNERS LIABILITY.
THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED BY CONTRACT
ENDORSEMENT FOR BUSINESS AUTO LIABILITY.
CERTIFICATE HOLDER CANCELLATION
378-466-7 12 0
CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
20 E MAIN ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ASHLAND,OR 97520-1814 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
1/444)1/14‘) )4A,%/
O 1988-2015 ACORD CORPORATION.All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
FEDERATED INSURANCE COMPANIES
THIS ENDORSEMENT MODIFIES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED BY CONTRACT ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS LIABILITY COVERAGE FORM
A. Paragraph C. Who Is An Insured is amended to include as an additional insured any person or organization,
other than a joint venture, for whom you are performing operations when you and such person or organization
have agreed in writing in a contract or agreement that such person or organization be added as an additional
insured on your policy. Such person or organization is an additional insured only with respect to liability for
"bodily injury", "property damage" or "personal and advertising injury"caused by your ongoing operations for
the additional insured and only to the extent that such "bodily injury", "property damage" or "personal and
advertising injury" is caused by your negligence or the negligence of those performing operations on your
behalf:
A person's or organization's status as an additional insured under this endorsement ends when your
operations for that additional insured are completed.
This additional insurance does not apply to:
1. An employee, association of employees or labor union, except with respect to work performed by or for
you for such employee, association of employees or labor union under direct contract between you as
contractor and such employee, association of employees or labor union as owners;
2. Any railroad company except with respect to work performed by or for you for such railroad company
under direct contract or agreement between you and such railroad company;
3. Any person or organization whose profession, business or occupation is that of an architect, surveyor or
engineer with respect to liability arising out of the preparation or approval of or the failure in preparation
or approval of maps, shop drawings, opinions, reports, surveys, field orders, change orders, designs,
drawings, specifications or the performance of any other professional services by such person or
organization; or
4. Any of your Subcontractors, or any partner, officer, agent or employee of such Subcontractor.
B. The Coverage extended to any additional insured by this endorsement is limited to, and subject to, all terms,
conditions, and exclusions of the coverage form to which this endorsement is attached.
In addition, Coverage shall not exceed the terms and conditions that are required by the terms of the written
agreement to add any insured, or to procure insurance.
C. In the event that the Limits of Insurance shown in the Declarations exceeds the limits of liability required in a
written contract or written agreement for an additional insured, the insurance provided to the additional
insured shall be limited to the limits of liability required by that written contract or written agreement.
D. Additional Exclusions
The insurance afforded to any person or organization as an insured under this endorsement does not apply:
1. To "bodily injury", "property damage" or"personal and advertising injury" which occurs prior to the date
of your contract with such person or organization;
2. To"bodily injury" or "property damage" included within the "products - completed operations hazard"; or
3. To "bodily injury", "property damage" or "personal and advertising injury" arising out of the sole
negligence of any person or organization that would not be an insured except for this endorsement.
Includes copyrighted material of Insurance Services Office, Inc.with its permission.
BP-F-115 (OR) (07-09) Policy Number:9283960 Transaction Effective Date: 06-06-2021
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED BY CONTRACT ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE PART
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless
modified by the endorsement.
A. WHO IS AN INSURED for"bodily injury" and "property damage" liability is amended to include:
Any person or organization other than a joint venture, for which you have agreed by written contract to
procure bodily injury or property damage "auto" liability insurance arising out of operation of a covered
"auto"with your permission. However, this additional insurance does not apply to:
(1) The owner or anyone else from whom you hire or borrow a covered "auto". This exception does
not apply if the covered "auto" is a "trailer" connected to a covered "auto"you own.
(2) Your "employee" if the covered "auto" is owned by that "employee" or a member of his or her
household.
(3) Someone using a covered "auto" while he or she is working in a business of selling, servicing,
repairing, parking or storing "autos" unless that business is yours.
(4) Anyone other than your "employees", partners (if you are a partnership), members (if you are a
limited liability company), or a lessee or borrower or any of their "employees", while moving
property to or from a covered "auto".
(5) A partner (if you are a partnership), or a member (if you are a limited liability company) for a
covered "auto" owned by him or her or a member of his or her household.
B. The coverage extended to any additional insured by this endorsement is limited to, and subject to all terms,
conditions, and exclusions of the Coverage Part to which this endorsement is attached.
In addition, coverage shall not exceed the terms and conditions that are required by the terms of the written
agreement to add any insured, or to procure insurance.
C. The limits of insurance applicable to such insurance shall be the lesser of the limits required by the
agreement between the parties, or the limits provided by this policy.
D. Additional exclusions. The insurance afforded to any person or organization as an insured under this
endorsement does not apply:
1. To "loss"which occurs prior to the date of your contract with such person or organization;
2. To "loss" arising out of the sole negligence of any person or organization that would not be an insured
except for this endorsement.
3. To "loss" for any leased or rented "auto" when the lessor or his or her agent takes possession of the
leased or rented "auto"or the policy period ends, whichever occurs first.
Includes copyrighted material of Insurance Services Office, Inc. with its permission.
CA-F-127 (03-03) Policy Number: 9283961 Transaction Effective Date:06-06-2021
378-466-7 12
PW N DH BS BN000-03-0143
WXW0021 XXXXXXX5##
Y OF ASHLAND
20 E MAIN ST
ASHLAND OR 97520-1814