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HomeMy WebLinkAboutInsurance Certificate: LTM, Inc 212 345-5000 6/5/2023 5 : 19: 08 PM PAGE , 2/003 Fax Server . • DATE(MMIDD/YYW) o� Ac CERTIFICATE OF LIABILITY INSURANCE `-�- 06/05/2023 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 NAONETACT Marsh)U.S.Operations • - MARSH USA LLC. 333 South 7th Street,Suite 1400 (AHC INo.Ext): 866-956-4664 (A/C,No): 212-948-5382 Minneapolis,MN 55402-2400 E-MAIL Minneapolis.CertRequest@marsh.com / ' INSURER(S)AFFORDING COVERAGE NAIC# CN103060364-LTMM-GAWX-23-24 2010 2037 LTMME Al Y INSURER A:Liberty Mutual Fire Ins Co 23035 INSUREDINSURER B:Berkshire Hathaway Specialty Insurance 22276 LTM,Incorporated • I • dba Knife River Materials / INSURER C: ' Medfordl145,OR 97501 • INSURER D: \ , l INSURER E: - INSURER F,: COVERAGES CERTIFICATE NUMBER: CHI-010373186-33 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. INSRTTYPE OF INSURANCE, . IANSD DDL SWVD 'POLICY NUMBER U BR POLICY PM'DDIYOLICY XP LINTS (MNYDDIYYYY) (MNYDD/YYYY) A X COMMERCIAL GENERALLIABILITY TB2-641-445905.323 01/01/2023 01/01/2024 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PREM SES(Ea occur ence) $ 1,000,000 MED EXP(Any one person) $ 10,000 PERSONAL 8 ADV INJURY _ $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X jE LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY AS2641446115033 06/01/2023 06/01/2024 COMBINED SINGLE LIMIT $ 5,000,000 r (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ OSSCHEDULED - AUTONLY AUOBODILY INJURY(Per accident) $ HIRED NON-OWNED . PROPERTY DAMAGE' $ AUTOS ONLY AUTOS ONLY (Per accident) B UMBRELLALIAB X OCCUR 47XSF32875101 06/01/2023 06/01/2024 EACH OCCURRENCE $ 5,000,000 X' EXCESS LIAB CLAIMS-MADE AGGREGATE $� 5,000,000 DED RETENTION$ 9 $ A WORKERS COMPENSATION WA264D446115013 06/01/2023 06/01/2024 X PER OTH- AND EMPLOYERS'LIABILITY - Y/N STATUTE ER AtJYPRc RIETOR/PARTNER/EXECUTIVEEL EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? n N/A (Mandatory In NH) - ' • ' E DISEASE-EA EMPLOYEE $ 1,000,000 Ifyyes describe under - DESGRIPTION OF OPERATIONS below ' ' E.L DISEASE-POLICY LIMIT $ 1,000,000 A General Liab.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 r , DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may he attached If more space Is required) Re:Al Operations City of Ashland is/are included as additional insured where required by written contract and does not include professional liability coverage. Blanket Additional Insured for Automobile Liabillly is included where required by written contract Excess labilly applies to general liablity,products and completed operations,automobile liability,and employers lability. ) . J 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 VVITH THE POLICY PROVISIONS. . Ashland,OR 97520 . AUTHORIZED REPRESENTATIVE 1 . f . I ' c�aeg!'7"�'P�y9z—Gr.-.4W ©1988.2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD . • / 212 345-5000 6/5/2023 5 : 19: 08 PM PAGE 3/003 Fax Server Marsh LISA00 Marsh LLC: 11001 Lakellr7e Blvd., Bldg. 1, Suite 200 A;lr:tfn.TX 78717 Mirrr¢eapu31s.Cert:RequestCmarsh.com • • June 2, 2023 To Whore it May Concern. The attached certificate sof insurance replaces any previously issued certificates you received for the Named insured. The actual policies are,in the process of being issued so endorsements cannot be provided at this time. For additional assistance, contact your local Knife River representative. Regards, U.S. Operations'iia.Technology I Marsh VSA LLC � 1 • • • 212 345-5000 . 6/5/2023 5 : 19: 08 PM PAGE 1/003 Fax Server • Facsimile Transmittal Sheet MARSH . An MMC Company From: Jesse Ortega To: City of Ashland Phone: - Fax: 541-488-5320 Date: 05-Jun-23 Attention: . Time: 04:18 PM V Company: Knife River Corporation • Message: This certificate replaces any previously issued. • • • • The information contained in this facsimile message is confidential,may be privileged,and is intended for the use of the individual or entity named above.If you, the reader of this message,are not the intended recipient,the agent,or employee responsible for delivering this information to the intended recipient,you are expressly prohibited from copying,disseminating,distributing, or in any other way using any of the Information contained in this facsimile message. 1