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HomeMy WebLinkAboutInsurance Certificate: Portland Engineering Inc (2) AC CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) I `..-''' 6/30/2020 1 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). CONTPRODUCER ACT Lynn Wray Ward Insurance Agency Inc. PHONEFAX PO Box 10167 (A/C.No.Ext):541-687-1117 . (A/C.No):541-342-8280 Eugene OR 97440 AOMDRess: lynn@wardinsurance.net 1 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Cincinnati Specialty Underwriters Insurance Compan 13037 INSURED PORTENG-01 INSURER B:Cincinnati Insurance Company 10677 Portland Engineering Inc 7675 High Banks Rd Ste 1 INSURER c:Commerce and Industry Insurance Company 19410 Central Point OR 97502 . INSURER D:Continental Casualty 20443 INSURER E: INSURER F: 1 COVERAGES CERTIFICATE NUMBER:108774.1956REVISION 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 TYPE OF INSURANCE ADDL SUBR - POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY). A X COMMERCIAL GENERAL LIABILITY Y Y CSU 0039055 7/1/2020 7/1/2021 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $100,000 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 578, LOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER: $ B AUTOMOBILE LIABILITY Y Y ENP 0148589 7/1/2020 7/1/2021 COMBINEDSINGLE LIMIT $1,000,000 (Ea accident) ANY AUTOBODILY 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) $ C UMBRELLA LIAB X OCCUR EBU0262459787/1/2020 7/1/2021 EACH OCCURRENCE $5,000,000. X EXCESS LIAB CLAIMS-MADE r AGGREGATE $5,000,000 DED RETENTION$ - $ WORKERS COMPENSATION PER OTH- AND,EMPLOYERS'LIABILITY Y/NSTATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE nE.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A - - (Mandatory In NH) El.DISEASE-EA EMPLOYEE.$ If yes,describe under„ - - - - -.- .. —. DESCRIPTION OF OPERATIONS below -E.L.DISEASE-POLICY LIMIT $ D Professional Liability MCH288379629 7/1/2020 7/1/2021 Limit$2,000,000 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 with waiver of subrogation as 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. • CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland Attn: David Gies , 20 E Main St AUTHORIZED REPRESENE Ashland OR 97520 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD • • COMMERCIAL GENERAL LIABILITY available to the additional insured whether Thio insurance will bo noncontributory only if CSGA4031 0612 primary,excess, contingent or on any other you have so agreed in a written contract or basis unless you have agreed in a written con- written agreement executed prior to any loss tract or written agreement executed prior to and this coverage is determined to be primary. THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. any loss that this insurance will be primary. ADDITIONAL INSURED-OWNERS, LESSEES OR CONTRACTORS -AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU- OPERATIONS AND COMPLETED.OPERATIONS(LIMITED) • • This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. SECTION II•- WHO IS AN INSURED is b. Supervisory,inspection,architectural amended to include as an additional insured or engineering activities. any person or organization when you and such person or organization have agreed in writing 2. "Bodily Mien/or"property damage"ads- in a ventrad or agreement that such person or_ ing out of'your.work"for which a consoli- organlzatlon be added as an additional Insured - - dated (wrap-up).insurance program has - -- - - - - - - - on your policy,but only to the extent that the li- been provided by the prime contractor/ ability is caused by"your work"performed for project manager or owner of the construc- that additional insured and only to the extent tion project in which you are involved. that such liability is caused by your negligence, 3. "Bodilyin' "per- acts or omissions or the negligence,acts or injury",advertisingProperty damage"anyoem- omissions sinal and injury'to em- omissions of those acting on your behalf. ployee of you or to any obligation of the If not spedfied otherwise in the written con- additional Insured to Indemnity another tract or agreement, a person's or organ'- because of damages arising out of such• tion's status as an additional insuredunder this injury. • endorsement ends one year after your opera- 4, "Bodily Injury,"property damage"or"per- tions for that additional insured are completed conal and advertising injury"for which the The written contract or agreement must be Named Insured is afforded no coverage, currently in effect or become effective during under this policy of insurance. the term of this Coverage Part.The contract or agreement must be executed prior to the'bod- C. With respect to the insurance afforded to ily injury","property damage"or"personal and these additional insureds,SECTION III-LIM- advertising injury'to which this endorsement ITS OF INSURANCE is amended to include: pertains. The limits applicable tothe additional.insured B. With respect to the insurance afforded to the- am those spedfied in the written contract or se additional insureds,the following additional agreement or In the Declarations of this Cov- exdusions apply: erage Part,whichever is less.If no limits are This insurance does not apply to: specified in the written contract or agreement, the limits applicable to the additional insured 1. "Bodily injury,"property damage"or"per- aro those cpocifiod.in tho Declarations of this sonal and advertising injury"arising out of Coverage Part.-The-limits of insurance are In- the rendering of,or the failure to render, elusive of and not in addtion to the limits of in- any professional architectural, engineer- suranoe shown in the Declarations: ing or surveying services,induding: D. With respect to the Insurance afforded to the- a. The preparing,approving,or failing to se additional insureds,SECTION.IV-COM prepare or approve, maps, shop MERCIAL GENERAL LIABILITY CONDI- drawings,opinions,reports,surveys, TIONS.4.Other Insurance Is amended to In- field orders,change orders or draw- elude: ings and spec cations;or Any coverage provided herein will be excess over any other valld and collectible Insurance Includes copyrighted material of Insurance Incudes copyrighted material of Insurance C30A 4031 0012 services Office,Inc.,with its permission. Page 13212 C30A 4031 0012 services Office,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 contract 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 contract 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 4087 12 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 inceptiondate of the policy unless another date is indi- cated below. Endorsement Effective: Policy Number: 07-01-2019 EBA 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. 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: 07-01-2019 .EBA 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. Blanket Waiver of Subrogation payments we make for"bodily injury' or"prop- ertySECTION IV - BUSINESS AUTO CONDI- damage" arising out of the operation of a A. Loss Conditions, 5. Transfer of covered "auto"when you have. assumed liabil- TIONS, Ri Rights of RecoveryAgainst Others to Us is ity for such"bodily injury"or"property damage" gunder 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 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: 07-01-2019 EBA 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