HomeMy WebLinkAboutInsurance Certificate: Carlson Construction (2) '4DATECERTIFICATE OF LIABILITY INSURANCE03/26/2021
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
FEDERATED MUTUAL INSURANCE COMPANY NAME: CLIENT CONTACT CENTER
HOME OFFICE:P.O.BOX 328 (A/C,No ,Ext(:888-333-4949 FAX.No):507-446-4664
OWATONNA,MN 55060 ADDRESS:CLIENTCONTACTCENTERaFEDINS.COM
INSURER(S)AFFORDING COVERAGE NAIC#
INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935
INSURED 184-097-0 INSURER B:
CARLSON CONSTRUCTION INSURER C:
PO BOX 1503
MEDFORD,OR 97501-0112 INSURER 0:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:8 REVISION NUMBER:2
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.
/LTR TYPE OF INSURANCE AINNSR SYy BD POLICY NUMBER IMM DID YYCY FYFY) (MMIDDITYPOLICY YV) ' ' LIMITS
X COMMERCIAL GENERAL LIABILITY .
EACH OCCURRENCE ( $1,000,000
CLAIMS-MADE n OCCUR PREMISES Ea RENTED $100,000
MED EXP(Any one person) EXCLUDED
A N N 9837473 10/06/2020 10/06/2021 PERSONAL&ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
POLICY n TA LOC PRODUCTS-COMP/OP AGO $2,000,000
OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000
(Ea accident)
X ANY AUTO
BODILY INJURY(Per person)
—
A OWNED AUTOS ONLY AUTOSULED N N 9837473 10/06/2020 10/06/2021 BODILY INJURY(Per accident
—
HIRED AUTOS ONLY NON-OWNED AUTOS ONLY (PPeraffer flROPERTY DAMAGE
X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $5,000,000
A EXCESS LIAR CLAIMS-MADE N N 9837474 10/06/2020 10/06/2021 AGGREGATE _ $5,000,000
DED I I RETENTION
WORKERS COMPENSATION OTH-
AND EMPLOYERS'LIABILITY Y/N
PER STATUTE ER
ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? N I A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
CERTIFICATE HOLDER CANCELLATION
184-097-4 8 2
CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
20 E MAIN ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ASHLAND,OR 97520-1814 ACCORDANCE WITH THE POLICY PROVISIONS.
•
AUTHORIZED REPRESENTATIVE '
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