Loading...
HomeMy WebLinkAboutInsurance Certificate: LTM, Inc ACORD® DATE(MM/DD/YYYY) �/. CERTIFICATE OF LIABILITY INSURANCE 12/07/2021 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 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 IANCNr PHONE 866-966-4664 866-966 4664 FAX No): 212-948-5382 Minneapolis,MN 55402-2400 EMAIL MDU.CertRequest©marsh.com Attn:MDU.CertRequest@marsh.com;Fax:(212)948-5382 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# CN102299309-LTMM-GAWX-22-23 2010 2037 LTMME Al Y INSURER A:Liberty Mutual Fire Ins Co 23035 INSURED INSURER B:Associated Electric&Gas Ins Services Ltd 3190004 LTM,Incorporated 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-007946941-29 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. INSRTYPE OF INSURANCE WADDL SUBR - POLICY EFF POLICY EXP LIMITS LTR INSD VD POLICY NUMBER (MM/DD/YYYY) (MMIDDIYYYYI A X COMMERCIAL GENERAL LIABILITY - TB2-641-005097-042 01/01/2022 01/01/2023 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES Ea occurrence) $ 1,000,000 MED EXP(My one person) $ 10,000 PERSONAL&ADV INJURY $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY X ZS: LOC • PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: $ A AUTOMOBILEUABILITY Al2-641-005097-052 01/01/2022 01/01/2023 COMBINED SINGLE LIMIT $ 2,000,000 (Ea accident) X ANY AUTO _ BODILY INJURY(Per person) $ OWNED SCHEDULED - BODILY INJURY(Per accident) $ AUTOS ONLY — AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) $ B UMBRELLA UAB OCCUR XL5063411P 01/01/2022 01/01/20235,000,000 F.ACH OCCURRENCE $ . X EXCESS UAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION$ $ C WORKERS COMPENSATION WA7-64D-005097-022(Regulated) 01/01/2022 01/01/2023 X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER WA7-64D-005097-012AOS 01/01/2022 01/01/2023 ANYPROPRIETOR/PARTNER/EXECUTIVE I ( ) 1,000,000 I NIA E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED7 (Mandatory InNH) "Includes"I "Stop-Gar" 1,000,000 In pGar" E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 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:All Operations City of Ashland is/are included as additional insured 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 20 48. Excess liability applies to general liability,products and completed operations,automobile liability,and employers liability. CERTIFICATE HOLDER CANCELLATION _ City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn:Kari Olsen THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 90 N.Mountain ACCORDANCE WITH THE POLICY PROVISIONS. Ashland,OR 97520 AUTHORIZED REPRESENTATIVE I :zz tda 24.5:74 9,4c, ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 0001469 SP 0545 -C01-P01469-1 City of Ashland Attn: Kari Olsen 90 N. Mountain Ashland, OR 97520 a 0545-01-00.0001469-0001-0005107 J•.. 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 cancellation,becomes 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 cancellationof.coverage is intended:.as a courtesy only. Our failure to provide such advancenotification will not extend the policy cancellation date nor negate:cancellation ofthe 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 bn'fiie 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.WA7-6413.005097-022 Effective Date Premium$ Issued to. MDU Resources Group, 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 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 noticeW.91e first named insured. B. This advance notification of a pending cancellation of coverage is intended es.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)I Email Addressor mailing,address: Number Days Notice: Organization(s): Per Schedule on file withlhe 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 Ne.WA7-040-005997-012 Effective Date Premium$ Issued to Centennial Energy Moldings,Inc. Endorsement No. WC 99.20 75 2018 Liberty Mutual Insurance Page. 1 of 1 Ed. 12/01/2016 0545-01 404001 469-0005-000811 1 Policy Number TB2-641-005097-042 ,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 'thannonpayment of premium,'. we will notify the persons or organizations .shown in the Schedule of this endorsemennt. We will send.notice.to,the email or mailing address listed above at least 10 days, or the number of dayslisted above, if any, before the cancellation becomes effective. In no event does the notice to the tlird: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 notificationwill 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 of file with the company 90 LIM 99 01 05 71 ©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:TB2-541-005097-042 COMMERCIAL GENERAL LIABILITY CG20371219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ,:.IT CAREFULLY. ADDITIONAL INSURED -- OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART A. Section II -- Who IsAn Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following 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 g provided to the additional insured is "property damage" caused, in whole or in part, by required by a contract or agreement the most we "your work" at the location designated and will pay on behalf 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-completedoperations hazard". 1. Required by the contractor agreement;or However: 2. Available under the applicable limits of insurance 1. The insurance afforded to such additional. insured onlyy applies to the extent permitted by whichever is less. law;and This endorsement shall not 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 for whom youhave agreed All locations as required by a.written contract or in writing in a contract or agreement, prior to an agreement entered into prior to an"occurrence"or "occurrence"or"offense",that such person or offense. organization be added as an additional insured on your policy;and 2.Any other person or organization'you are required to add as an additional insured under the contract or agreement described in item(1)above. Information'required to complete this Schedule,if not shown above,will be shown in the Declarations. CG 20 37 12 19 © Insurance Services Office,Inc.,2018 Page 1 of j i 0545-01-00-0001469-0004-0008110 POLICY NUMBER:TB27641-005097-042 COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 SCHEDULE (Continued) Name Of Additional Insured Person(s) Or Organization(s): Locatfon(s)Of Covered Operations Any person or organization with whom you have agreed All locations as required by a written contract or in writing in a contract or agreement prior to an agreement entered into prior to an"occurrence"or "occurrence"or"offense",that such person or offense. organization be added as an additional insured on your • policy;and 2.Any other person or organization you are required to add as an additional insured.under the contract or agreement described in item(1)above. . information required to complete this Schedule,if not shown above,will be shown in the Declarations. CG 20 10 12 19 ID Insurance Services Office, Inc.,2018. Pagel of 2 POLICY NUMBER:1B2-841-005097-042 COmmERCIAt.GENERAL LIABILITY .CG 20 10 1;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 only With Work, on the project (other than serVice, respect to liability for "bodily injury"; 'propertymaintenance or„repair's) 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 lotation of the covered -operationS has been 1. Your acts or omissions;or lcompleted;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 broaderthan that which you.are required Required by the contract or agreenient:oi 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 CG 20 10 12 19 ( Insurance Services Office,Inc.,2018 Pagel of 2 41, 0545-01-00-0001469-0003-0008109 Policy Number:Ai2-691-OO5097-052 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 T 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 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. LIM 99 01 0511 ©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:Al2-641-005097-052 COMMERCIAL AUTO CA 20 48 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, the provisions 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, if nolahnapciVe,will be shown ihthe Declarations: Each person or organization shown in the Schedule is an "insured"for CoveredAutos Liability Cbverage,but only tathe 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 Cartier Coverage Forms and Paragraph 112.of Section I - Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 C)Insurance Services Office, Inc., 2011 Page 1 of 0545-01-00-0001469-0002-0008108