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HomeMy WebLinkAboutInsurance Certificate: Portland Engineering Inc A ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM!DD1YYY) 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 ICONTACT Ward Insurance Agency, Inc. PHONE Mary-Beth Woomer FAX P.O. Box 10167 (A/c.No.Eat):541-687-1117 (A/c.No):541-342-8280 Eugene OR 97440-2167 ADDRess: mary-beth@wardinsurance.net INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Cincinnati Specialty Underwriters Insurance Compan 13037 INSURED PORTENG-01 INSURER B:Cincinnati Insurance Company 10677 Portland Enginksring, n. Unit High Banks Rd., Unit 1 INSURER c:Commerce and Industry Insurance Company 19410 Central Point OR 97502-9521 INSURER D:Continental Casualty 20443 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:2096542155 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) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY V Y CSU 0039055 7/1/2021 7/1/2022 EACH OCCURRENCE $1,000,000 CLAIMS-MADE .X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $500,000 MED EXP(Any one person) $0 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 _ POLICY X ECOT- LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ B AUTOMOBILE LIABILITY Y Y ENP 0148589 7/1/2021 7/1/2022 COMaaccidBINEDenU SINGLE LIMIT $1,000,000 (E ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURYPer accident) $ AUTOS ONLY AUTOS ( X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY _ AUTOS ONLY (Per.accident) $ C UMBRELLA LIAB X OCCUR BE023118506 7/1/2021 7/1/2022 EACH OCCURRENCE $5,000,000. X EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N. STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ D Professional Liability MCH288379629 7/1/2021 7/1/2022 Limit$3,000,000 Ded:$5,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder and all entities required by written contract are included as additional insureds on a primary and non-contributory basis with waiver of subrogation with respects to the general liability including completed operations and auto liability as required by written contract per attached endorsements. Subject to policy limits,terms,conditions and exclusions. UBI#601859858 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 20 E Main St AUTHORIZED REPRESENTATIVE Ashland OR 97520 71' � ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD • COMMERCIAL GENERAL LIABILITY 4. 'Bodily injury","property damage"or"per- D. With respect to the insurance afforded to CSGA 4371213 sonal and advertising injury"for which the these additional insureds, SECTION IV - Named Insured is afforded no coverage COMMERCIAL GENERAL LIABILITY CON- under this policy of insurance. DITIONS,4.Other Insurance is amended to THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. C. With respect to the insurance afforded to indude: these additional insureds,SECTION III-LIM- Any coverage provided herein will be excess ADDITIONAL INSURED-OWNERS, LESSEES OR ITS OF INSURANCE is amended to include: over any other valid and collectible insurance The limits available to the additional insured whether CONTRACTORS -AUTOMATIC STATUS WHEN applicable to the additional insured primary, excess, contingent or on any other are those specified in the written contract or basis unless you have agreed in a written con- REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU - agreement or in the Declarations of this Cov- erage Part,whichever is less.If no limits are any loss that this insurance will be primary. OPERATIONS AND COMPLETED OPERATIONS specified in the written contract or agreement, This insurance will be noncontributory only if the limits applicable to the additional insured you have so agreed in a written contract or are those specified in the Declarations of this written agreement executed prior to any loss This endorsement modifies insurance provided under the following: Coverage Part.The limits of insurance are in- and this coverage is determined to be primary clusive of and not in addition to the limits of in- surance shown in the Declarations. COMMERCIAL GENERAL LIABILITY COVERAGE PART A. SECTION II - WHO IS AN INSURED is amended to include as an additional insured 2. If coverage provided to the additional in- any person or organization when you and such sured is required by a contract or agree- person or organization have agreed in writing ment,the insurance afforded to such ad- in a contract or agreement that such person or ditional insured will not be broader than organization be added as an additional insured that which you are required by the can- on your policy,but only with respect to'bodily tract or agreement to provide for such ad- injury","property damage" or"personal and ditional!insured. advertising injury"caused,in whole or in part, B. With respect to the insurance afforded to by: these additional insureds,the following addi- 1. Your acts or omissions in the perform- tional exclusions apply: ante of your ongoing operations for the This insurance does not apply to: additional insured; 2. The acts or omissions of those acting1. 'Bodily injury","property damage"or"per- 2. on sonal and advertising injury"arising out of your behalf in the performance of your the rendering of,or the failure to render, - ongoing operations for the additional in- any professional architectural, engineer- sured;or ing or surveying services,including: 3. "Your work"performed for the additional a. The preparing,approving,or failing to insured and induded in the "products- prepare or approve, maps, shop completed operations hazard". drawings,opinions,reports,surveys, If not specified otherwise in the written con- field orders,change orders or draw- tract or agreement, a person's or organize- ings and specifications;or lion's status as an additional insured under this b. Supervisory, endorsement ends one year after your opera- or engineeringarcitectural activities. tions for that additional insured are completed. The written contract or agreement must be 2. 'Bodily injury"or"property damage"aris- currently in effect or become effective during ing out of"your work"for which a consoli- the term of this Coverage Part.The contractor dated (wrap-up) insurance program has agreement must be executed prior to the"bod- been provided by the prime contrac- ily injury","property damage"or"personal and tor/project manager or owner of the con- advertising injury"to which this endorsement struction project in which you are involved. pertains. 3. 'Bodily injury","property damage"or"per- However: sonal and advertising Injury'to any em- 1. The insurance afforded to such additional ployee of you or to any obligation of the additional insured to indemnity another insured only applies to the extent permit- because of damages arising out of such ted by law;and injury. - Includes copyrighted material of ISO Includes copyrighted material of ISO CSGA 437 12 13 Properties,Ina,with its permission. Page 1 of 2 CSGA 437 12 13 Properties,Inc.,with its permission. Page 2 of 2 COMMERCIAL GENERAL LIABILITY CSGA 4087 12 12 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US - PER CONTRACT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to Paragraph 8.Transfer of Rights of Recovery Against Others to Us of SECTION' IV-CONDITIONS: If you have agreed, in a written contrail or agreement, to provide a waiver of any right of recovery against a person or organization, we will waive any right of recovery we may have against that person or organization because of payments we make for injury or damage arising out of your ongoing operations or'your work"done under a contrail with that person or organization and included in the "products-completed operations hazard". This waiver applies only to that person or organization for which you have agreed to in a written contract to provide said waiver. Includes copyrighted material of Insurance CSGA 408712 12 Services Office, Inc.,with its permission. Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED BY CONTRACT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM This endorsement changes the policy effective on the inception date of the policy unless another date is indi- cated below. Endorsement Effective: Policy Number: 07/01/2021 E B A 014 85 89 Named Insured: PORTLAND ENGINEERING INC Countersigned by: (Authorized Representative) With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. SECTION II - LIABILITY COVERAGE, A. Cover- age, I. Who is an Insured is amended to include as an insured any person or organization with which you have agreed in a valid written contract to provide insurance as is afforded by this policy. This provision is limited to the scope of the valid written contract: This provision does not apply unless the valid written contract has been executed prior to the "bodily injury"or"property damage". AA 4171 11 05 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY INSURANCE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM This endorsement changes the policy effective on the inception date of the policy unless another date is indi- cated below. Endorsement Effective: Policy Number: 07/01/2021 E B A 014 85 89 Named Insured: PORTLAND ENGINEERING INC Countersigned by: (Authorized Representative) With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. 1. Noncontributory Insurance SECTION IV - BUSINESS AUTO CONDI- TIONS, B. General Conditions, 5. Other In- surance is replaced by the following: c. Regardless of the provisions of Para- graph a. above, this Coverage Form's Li- ability Coverage is primary and we will not seek contribution from any other in- surance for any liability assumed under an "insured contract"that requires liability to be assumed on a primary noncon- tributory basis. AA 4174 11 05 • , ( THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF SUBROGATION - AUTO This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM This endorsement changes the policy effective on the inception date of the policy unless another date is indi- cated below. Endorsement Effective: Policy Number: 07/01/2021 ERA 014 8 5 89 Named Insured: PORTLAND ENGINEERING INC Countersigned by. (Authorized Representative) With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. 1. Blanket Waiver of Subrogation payments we make for"bodily injury' or"prop- erty damage" arising out of the operation of a covered "auto"when you have assumed liabil- TIONS, A. Loss Conditions, 5. Transfer of ity for such"bodily injury"or"property damage" Rights of Recovery Against Others to Us is under an"insured contract", provided the"bod- amended by the addition of the following: ily injury"or "property damage" occurs subse- We waive any right of recovery we may have quent to the execution of the "insured con- against any person or organization because of tract". AA 4172 09 09