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HomeMy WebLinkAboutInsurance Certificate: LTM, Inc. 212 345-5000 6/29/2023 5 : 2510 PM PAGE 2/008 Fax Server • z , ACORD`� • DATE(MMIIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 06/292023 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 LLC. NAME: p 333 South 7th Street,Suite 1400 (A/C,N.Ext): 866-966-4664 FAx No): 212"948'5382 Minneapolis,MN 55402-2400 E-MAIL Minnea olis.CertRe uest@marsh.com ADDRESS: p q . INSURER(S)AFFORDING COVERAGE NAIC# CN103060364-LTMM-GAWX-23-24 2010 2037 LTMME Al N INSURER A:Liberty Mutual Fire Ins Co 23035 INSURED INSURER B:Berkshire Hathaway Specialty Insurance 22276 • LTM,Incorporated dba Knife River Materials INSURER C: POBox 1145 - Medford,OR 97501 INSURER o INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: CHI-010373186-34 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. NOTWffHSTANDING 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 IINSD ADDL WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MM'DD/YYW1 (MM'DDA'YYY) A X COMMERCIAL GENERAL LIABILITY TB2-641-445905-323 01/01/2023 01/012024 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR . DAMAGE TO RENTED • PREMISES(Ea occurrence) $ 1,000,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 . GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JE LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILELIABILITY AS2641446115033 06/01/2023 06/012024 COMBINED SINGLE LIMIT $ 5,000,000 • (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ , AUTOS S • DONLY SCHEDULEDULEBODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ • AUTOS ONLY _ AUTOS ONLY (Per accident) .,.- B B UMBRELLA LIAB X OCCUR 47XSF32875101 06/01/2023 06/012024 EACH OCCURRENCE $ 5,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED. RETENTION$ $ A WORKERS COMPENSATION WA2640446115013(AOS) 06/01/2023 06/012024 X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER A. Y/N WC2641446115063N 06/01/2023 06/012024 ANYPROPRIETOR/PARTNER/EXECUTIVE ) EL EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? n N/A (Mandatory In NH) E DISEASE-EA EMPLOYEE $ '1,000,000 lives describe under 1,000,000 DESG�RIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ A General Liab.Excess Buffer TL2641446l15043 06/01/2023 06/012024 Each 0cc/Pers.&Adv.Injury 4,000,000 GL Agg./Prod.-Comp Ops Agg 4,000,000 • DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Re:Al Operations . City of Ashland is/are included as additional insured where required by written contact and does not include professional lability coverage. Blanket Additional Insured for Automobile Liability is included where • required by written contract. Excess(ability applies to general liability,products and completed operations,automobile liability,and employers Lability. • 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 of Marsh USA LLC • O 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD • 212 345-5000 6/29/2023 5 : 25: 10 PM PAGE 3/008 Fax Server •y , POLI ;Y N1tiM1 ER:AE2- 41-446115-113:1: COMMERCIAL AUTO CA2048 1Ct13 t" THIS ENDORSEMENT CHANCES THE POLICY. PLEASE READ IT CAREFULLY.. • D.ESIGNATED INSURED FOR COVERED AUTOS LIABILITY 'COVERAGE. This endorsement modifies insurance provided under,the fallowing: • AUTO DEALERS COVERAGE FORM • Lit SihE$a AUTO COVERAGE GE F ORM MOTOR CARRIER COVERAGE FORM With respect to ocverege provided by this`endoi'senaent._ .the pr'ovislons :of the Coverage Forth apply unless • \ modified by the endorsement • t .This endorsement identifies person(s.)or organizetion(s)who are":nsure:ds" for Covered Autos Liab:i:ty Coverage under the Who is An Insured provision of the.Coverage Form. This endorsement does not after coverage provided in the Coverage Form, • SCHEDULE • • Name Of Persons)Or Organization(s): Any person or organization where the named.insured.has•agreed.by Ltirtten contract to include such person or organization as a. designated insured, • • • • • Ir-fc�rrhalion required to eon-Vete this Schedule„ if not Shown above?,will tie st awl.)in the Declarations. Each person or organization shown in the Schedule • ie an"insured"for Covered Autos Lie bitityCoverage,but . only to'the extent that person or orgai lizatiort'qualifie. as an gins Li red'under the Who is An Inured protiision contained in Paragraph A.1.of Section li - Covered • • • Autos Liability Coverage In •the Business ,Auto and Motor Carrier Coverage Forms and Perayraph D.2.of • Section 1 - Covered Autos Coverages of -the Auto Dealers Coverage Form. • i r . • CA 20 48 1013 ©insurance Services Office.inc., 2011 Pagel oif' 212 345-5000 6/29/2023 5 : 25 : 10 PM PAGE 4/008 Fax Server • Policy Number:1142.-6.41-446115-033 is>sw.d: Gey: Liberty Mutual Viz' Insuranee co: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. N,OTiCE QF CANCELLATION TO THIRD PARTIES TTtls.endorsement modifies insurance provided under the following: • 3U SINESS AUTO COVERAGE PART .MOTOR CARRIER COVERAGE PART GA.RAGE'COVERAGE PART TRUCKERS COVERAGE PARI' EXCESS AUTOMOBILE LIABILITY INDEMNITY COVERAGE PART SELF-INSURED TRUCKER EXCESS LIABILITY COVERAGE PART • COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS COMMERCIAL GENERAL LUABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS.LIABILITYCOVERAGEPART • LIQUOR LIABILITY COVERAGE PART Schedule Name of Other Person{.$)/ Email Address or mailing Number Organizations;: address: Days Notice: Ter schedule of certificate holders Per schedule of. certificate. holder 90 :on file with .the company asn file with the-company • • A. If we (lancet this policy for any reason other than nonpayment of preiYiii,m, we will notify t e pens or organizations shown in the 'Schedule above. We will send notice.to the email or mailir g. address listed • above at least 10 days, or the number of days listed above, It any before the cancellation becomes effective. In no event does the notice to the third party exceed Tie notice to the:first named insured. B. This advance notification ale peri.d.ng canceilat;on or coverage ie intended as a courtesy only./ Oa failure • • to provide such advance notification will not extend the policy cancellation date nor negate to cancellation of The policy. Ail other terms and conditions of this policy remain unchanged. LIM 99 01 0511 ©2011, Liberty Mutual Group of Companies. All rights reserved. P isle 1 of 1 Ii clud s.copyrighted material of insurance Services Office, Inc: with Its permission. .212 345-5000 6/29/2023 5 : 25 : 10 PM PAGE 5/008 Fax Server • t_<CY NUMBER;TB2.-sad i4461 15-023 COMMERCIAL GENERAL LIABILITY CG"20 1012 19 THIS ENDORSEMENT CHANG THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ®ADDOWNERS, LESSEES, R CONTRACTORSSCHEDULED PERSOOR N dITI This endorsement'modifies insurance provided.under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART . • • A, Section 31 - Who Is M Insured.is ame.ndect do 1. All Work, including materials, parts or include.z�s an additional insured the person(s) tar` , equipment furnished in connection with such organization(s) shown itrthe Schedule: but only with work, on the project (other than service, respect to liability for "bodily injury", "property maintenance or repairs) to be perform d. by-de damage" or "personal and advertising injure on behalf of the additional insured(sj-at the caused,in whole or in part. bye - location of the covered operations has been 1. Your acts or.ornissions:et completed;Or 2. The-acts or omissions bf• 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•pi?rfr>rr iaricr� of yout'.or.•cic�ii7q operations for • intended use by. any persion or organization ether than another contractor or subcontractor -the additional insured(s) at the locations engaged in performing dpetc*tionis for a • desk;Hated abcree: principal a5 a part cif the same pro ect. However: C./With respect to the insurance afforded to these 1. The. 'insur'ance afforded to such additional • additional-. insureds, the following Is added to insured only applies to the extent permitted by Section tall-Limits:Of insurance:' ' law; end 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 o tract or agreement, the will pay on behalf of the additional insured is the insurance afforded to such additional insured will amount of insurance: not ire: broader than that.which you are required 1. Required by the contract or ayreernerit;or by the contract car agreement Ler 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 :?+pp}ic:ab!e limits of insurance,.. • "property damage"occurringafter: • • Schedule Name Of Additional Insured Person(s) Location( )QfCovered Operations • Or Orgartiztion(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 'occurs°e_rice or • "occurrence" or offense, that such person or offense. organization tie added as an additional insured to yore- pxalicy. Information required to conipl:ete'this Schedule,if not shown above,will be stool£n in the Declarations. • . , CG al 1012119 i?Insurance Services Office, Itrc.:-2Q1a Dare -1 of 1 212 345-5000 6/29/2023 5 : 25 : 10 PM PAGE 6/008 Fax Server . • • POL_tCY NUMBER:TB2..641-445115-023 l COMMERCIACGENERAL LIA8ILITV CG 20 371219 • THIS ENDORSEMENT CHANGES THE POLIO!. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES .OR CONTRACTORS - COMPLETED OPERATIONS This•endorsement nlodifies insurance provided under the following: C.OMM•ERdAL GENERAL LIABILITY.Y.COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILt e COVERAGE PART • A. Section II -- Who Is An Insured is amended to 1. \Mth respect to the insurance afforded .to these include as an additional insured.the person(s) or additicna insureds. the following is added to organization(s) .shown, in the Schedule, but only Section III...Lirriifis Of Insurance: With respect to lability .Ino ::'bodily ifju..rJ' or if coverage. provided to the additiona. insured is"prciPerty *damage" caused, in whole or in part, by required by a contract or .agreement, this: most we you work at the* location designated :incl MI • described in the. Schedule of. this endorseme t pay oh behalf of the additiopal insured is the • performed for that additional insured and included am int of insurance: . in the"'prodtici.s-completed operations hazard". 1. Required by the contract or agreement;or Hoverer: 2. Available under ,the applicable limits of 1, The insurance afforded, to such additional insurance.; insured only applies to the extent'jaermilted. by whichever is less. law; and • This endorsement shall not increase the applicable. 2. If coverage provided to the additional insured is limits Of.• 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 Perzon:(s) . Or Organization{s): • Location And Description Of'Completed Operations • Any person or arrlanization for whom you have.agreeci AlE locations as required by a written contract ca in a written'contract agreement, prior to an agreement entered into prior to an "cccurrent6'or "occurrence!' or offense,that such person or offense.. organization be:added as an additional insured to your p dicy. . Information required to compete this Schedule,if not she ern ahcwe,will be shown in the Declarations. • • • CG20371219 • Insurance Services Office,.(roc.,.2018 S • Page 1 of '1 212 345-5000 6/29/2023 5 : 25 : 10 PM PAGE 7/008 Fax Server • • Policy Number'TS2-641-' 4S'I'15-023 Issued by Liberty Mutual Fina Insurance Co. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. • • NOTICE OF CANCELLATION TO THIRD PARTIES • • • tliia endorsement modifies insurance provided under the following; • BUSINESS AUTO COVERAGE PART MOTOR'CAR1 IER 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 OPERATIQN•S LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART • COMMERCIAL LIABILITY - UMBRELLA COVERAGE FORM A If we r',aricet' tlli4 policy for arty reason Other than- nonpayment of premium, we will nolify the persons of orge nli,&ions shown in the Schedule of this endorsemernt, We Swill soot rtLlti*e(to the.erneil or mailing address listed above at test W days. or the nurliber of. days listed above, if arty, before the cancellation becomes effer,fiwl. In event does the notice to the third party exceaald the notice. to the-first named insured. B. This advance r tit1c tion of is pending r rrartdetieation of coverage- is intended as a courtesy only. Our tallurr to: INC yfoe such advance stolificatlurt will riot extend the policy cancellation date nor negate cancellation of the: pocky. • Alt other terms end conditions of•this policyrerrain [ruts#larged. • • Schedule • Name of Other Person(s)/ Email Address or mailing address: Number Days Notice,: Organizetion(s): • "Ppr Suhedukk On t'13e With Tile Cgz3pa;tr "P6r 3.:11+Y.14.1141.On '6'Jith The Consp:+rij 9(1 • • • • • • • LtM 9�g 011)511 - i 2011; Liberty MUM:0 Gi•ouP of Companies. All rights reserved. Page t of I Iricludesscopyrighted materiai.of insurance Services Office; Inc.,with its.Ilcrmi<ision. . 212345-5000 6/29/2023 5 : 25 : 10 PM PAGE . 8/008 Fax Server • • • NOTICE OF.CANCELLATION TQ 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 Ito. ' provide such advance notification will not extend the policy cancellation date nor negate'cancellation of the policy. • Schedule. • Name of Other Person(s)! Eniail••Addreas or mailing address: Number Days Notice: Organization(s): • Schedule-on file with.the Schedule.on file:with the 90 Company Company • • • • • • • • • • • All Ohio-terms and"conditions of this policy remain unchanged. Issued by Liberty Mi,itual Fire•Insurance Company.16586 • • For attachment to Policy No.WA2-64D-448115-013 Effecive Date. 'Premium$ •Issued to Knife River'Corporation Endorsement.No. • • • WC 992075 ©2016 Liberty Mutual Insurance Page 1 of 1 Ed.12101/2016 • ` . 212 345-5000ImE 6/29/2023 5 : 25 : 10 PM PAGE 1/008 Fax Server img . ” • Facsimile Transmittal Sheet , • MARS H An MMC Company , From: Jesse Ortega To: City of Ashland Phone: Fax: 541-488-5320 Date: 29-Jun-23 Attention: Time: 04:20 PM Company: Knife River Corporation Message: _ • • •1 1 • • 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. y� �`�;� ��ui+iii?�`�t ind ....111111111thigi. ............ ,.,,.....v:::::;•::::::.:..,,...�.....,.. ..•:::.,•::::.,•:•:::.:�:::•:::.:•::::.:�:::::::.,•::+:::::.�:>:.::::�::::•::;•:;•:::>::::::..-. .:::.:::•>::::;::is i::: • f