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HomeMy WebLinkAboutInsurance Certificate: LTM Inc " ® A 0 CERTIFICATE. OF LIABILITY INSURANCE DATE(MM/DD/YYYI')06/29/2023 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 CT Marsh I U.S.Operations ` • MARSH USA LLC. • 333 South 7th Street,Suite 1400 We Nr o.Ext): 866 986-4664 FAX No): 212-948-5382 • Minneapolis,MN 55402-2400 E-MAIL Minneapolis.CertRequeSt@marsh.com quest@marsh.com . ADDRESS: p q . INSURER(S)AFFORDING COVERAGE • NAIC# CN103060364-LTMM-GAWX-23-24 LTMME INSURERA:Liberty Mutual Fire Ins Co 23035 ' INSUREDLTM,Incorporated • INSURER B:N/A . N/A ' dba Knife River Materials • INSURER C: PO BOX 1145INSURER D Medford,OR 97501 • INSURER E: _ _ . INSURER F: . . • COVERAGES' CERTIFICATE NUMBER: CHI-010373300-11 • •• 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/DDIYYYY) (MM/DD/YYYY) . LIMITS • A X. COMMERCIAL GENERAL LIABILITY . TB2-641-445905-323 01/01/2023 01/01/2024 EACH OCCURRENCE • $ 1,000,000 DAMAGE TO RENTED ', CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) • $ 1,000,000 MED EXP(Any one person) $ 10,000 • PERSONAL&ADV INJURY $ .1,000,000 • GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JECT LOC PRODUCTS-COMP/OP AGG $' 2,000,000 •. OTHER: - 0 $ A 'AUTOMOBILE LIABILITY AS2641446115033 . 06/01/2023 . 06/01/2024 COMBINED SINGLE LIMIT $ • 5,000,000 • (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED - _ • BODILY INJURY(Per accident) V AUTOS ONLY AUTOS • HIRED NON-OWNED • PROPERTY DAMAGE - $ AUTOS ONLY. AUTOS ONLY •• (Per accident) $ • UMBRELLA LIAB — OCCUR EACH OCCURRENCE' $ ' EXCESS LIAR CLAIMS-MADE AGGREGATE $ • .. DED RETENTION$ $ • A WORKERS COMPENSATION WA264D446115013(AOS) 06/01/2023 06/01/2024 X 'MUTE EE ETH- AND EMPLOYERS'LIABILITY STATUTE 6/01/2024 1000000 OFFICER/MEMBER EXCLUDED?ECUTIVE N N/A E.L.EACH ACCIDENT $ , , (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ .1,000,000 . ryes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A General Uab.Excess Buffer • TL2641446115043 06/01/2023 06/01/2024 . Each Occ/Pers.&Adv.Injury 4,000,000 . GL Agg./Prod.-Comp Ops Agg 4,000,000 • DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required). • . . Re:Asphalt Delivered. • ' The City of Ashland and its officers,employees,and agents while acting within the scope of their duties as such is/are included as additional insured under general liability where required by written contract and does not include professional liability coverage. • . Blanket Additional Insured for Automobile Liability is included where required by written contract. Primary and Non-Contributory applies for General Liability where required by written contract. CERTIFICATE HOLDER • .CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 90 N.Mountain Ave. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Ashland,OR 97520 • ACCORDANCE WITH THE POLICY PROVISIONS. ' AUTHORIZED REPRESENTATIVE of Marsh USA LLC • I • • . ' ©1988-2016 ACORD CORPORATION. All rights reserved.• ACORD 25(2016/03) The ACORD name'and logo are registered marks of ACORD POLICY NUMBER:AS2-641-446115-033 . 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 where the named insured has agreed by written contract to include such person or organization as a designated insured. . Information required to complete this Schedule, if not shown:above,will be shown in the Declarations. • Each person or organization shown in the Schedule is an"insured"for Covered Autos Liability Coverage,but only to the extent that person or organization qualifies as an"insured"under the Who Is An Insured provision contained in Paragraph A.1.of Section II - Covered Autos Liability Coverage,in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2.of Section I - Covered Autos Coverages of the Auto . . Dealers Coverage Form. • • CA 20 48 1013 © Insurance Services Office, Inc., 2011 Page 1 of 1 Policy Number:A52-641-446115-033 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 • Schedule • Name of Other Person(s)/ J Email Address or mailing Number Organization(s): address: Days Notice: Per schedule of certificate holders Per schedule of certificate holder 90. • on file with the 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:TB2-641-446115-023 COMMERCIAL GENERAL LIABILITY CG20101219 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", "property maintenance or repairs) to be performedby or damage" or "personal and advertising . injury" on behalf of the additional insureds) at the caused,in whole or in part, by: location of the covered operations has been 1..Your:acts or omissions;or J completed; 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 in the performance of your ongoing operations for • )intended use by any person or organization the additional insured(s) . at. the. location(s) other than another contractor or subcontractor designated above. t engaged in performing operations for a 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 tothe 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 broader. than that which you are required 1. Required by the contract or agreement;or by the,contract oragreement to provide for such additional insured: .2. Available under the applicable. limits of B. With respect to the insurance afforded to these insurance; 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 limitsof insurance. "property damage"occurring after: . Schedule Name Of Additional Insured Person(s) Loc ation(s)°Of Covered Operations Or Organization(s): Any person or organization for whom you have agreed All locations as required by a written contract or in a written 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 to your . . policy. . Information required to complete this Schedule,if not shown above,will be shown in the.Declarations. CG 20101219 • . ©Insurance Services Office, Inc.,2018 Page 1 of 1 • • • • • • POLICY NUMBER:TB2-641-446115-023 COMMERCIAL GENERAL LIABILITY CG 20 37 12 19 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 Is An 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 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-completed operations hazard". • , 1. Required by the contract or agreement or However: • 2. Available under the applicable limits of • 1. The insurance afforded to' such additional insurance; insured only 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 ororganization for whomyouhave agreed All locations as required by a.written contract or in a written 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 to your • • - • policy. •. 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 1 • Policy Number.TB2-641-446115-023 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 i TRUCKERS COVERAGE PART 0 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 'otherthan nonpayment of premium, we will notify the persons or organizations shown in the Schedule of this endorsement. We will send noticeto the email or mailing address listed above et 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. Schedule • Name of Other Person(s) / Email Address or mailing address: Number Days Notice: Organization(s): "Per Schedule Olt File With TheCompany "Per Schedule On File With The Company" 90 LIM 99 010511 ©2011, Liberty Mutual.Group of Companies. All rights reserved. Page 1 of 1 Includes copyrighted material of.Insurance Services Office, Inc.,with , its permission. COMMERCIAL GENERAL LIABILITY CG 20 01 1219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION • This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED.OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2)You. have.agreed in writing in a contract or Condition and supersedes any , provision to the agreement that this insurance would be contrary: primary and.would. not seek contribution Primary And Noncontributory Insurance,. from any other insurance available to the • This insurance is primary to and will. not seek additional insured. contribution from any other insurance available to an additional insured under your policy provided that (1) The additional insured is a Named Insured under such other insurance;and. • • • • • . , • • • • • • • CG 20 01 1219 ©Insurance Services Office, Inc.,201.8 Page 1 of 1 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 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. • • Schedule Name of Other Pertor(s)/ Email Address or mailing address: Number Days Notice: Organization(s): Schedule on file with the • Schedule on file with the 90 Company Company • • • • • All other ternis and conditions of this policy remain unchanged. • • issued by Liberty Mutual Fire Insurance Company 16586 Fofattachrnent to Policy No.WA2-64D-446115-013 Effective Date Pre inium$ • Issued to Knife River Corporation Endorsement No. • INC 99 20 75 ©2016 IJberty Mutual Insurance Page 1 of 1 Ed.12101/2016 •