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HomeMy WebLinkAboutInsurance Certificate: Carlson Construction RO 0® AC DATE#14MMDrnrwl-- CERTIFICATE OF LIABILITY INSURANCE 08/192021 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 CONTANAME:CT CLIENT CONTACT CENTER FEDERATED MUTUAL INSURANCE COMPANY PHONE HOME OFFICE:P.O.BOX 328 IA/C,No,Ext):888-333-4949 FAX No):507-446-4664 OWATONNA,MN 55060 E-MAIL CLIENTCONTACTCENTER(aIFEDINS.COM INSURER(S)AFFORDING COVERAGE _ NAIC# INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 184-097-4 INSURER B: CARLSON CONSTRUCTION INSURER C: PO BOX 1503 MEDFORD,OR 97501-0112 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:8 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 OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD (MM/DDIYYYY) (MMIDDIYYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE n OCCUR PREMISES Ea RENTED currrrence) $100,000 MED EXP(Any one person) EXCLUDED A N N 9837473 10/06/2021 10/06/2022 PERSONAL a ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPUES PER: GENERAL AGGREGATE $2,000,000 POLICY rim LOC_..] PRODUCTS-COMP/OP AGO $2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE UMIT • $1,000,000 IEa accident) X ANY AUTO BODILY INJURY(Per person) — • A OWNED AUTOS ONLY —IAUTOOSULED N N 9837473 10/06/2021 10/06/2022 BODILY INJURY(Per accident) — —HIRED AUTOS ONLY NON-OWNED PROPERTY DAMAGE _AUTOS ONLY (Per accident) I X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $5,000,000 A EXCESS LIAR CLAIMS-MADE N N 9837474 10/06/2021 10/06/2022 AGGREGATE $5,000,000 DED I I RETENTION WORKERS COMPENSATION PER STATUTE OER- AND EMPLOYERS'LIABILITY Y/N - ' ANY PROPRIETOR/PARTNER/EXECUTIVE1 E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? I N 1 A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE It yes,describe under - DESCRIPTION OF OPERATIONS below EL DISEASE•POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101.Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION 184-097-4 8 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 4/444)14,d ‘ )4A". . © 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2018/03) The ACORD name and logo are registered marks of ACORD