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HomeMy WebLinkAboutInsurance Certificate: Grayback Forestry Inc (2) . , .------" , ACCPRd . - OF cokTE.(mmowyyyy) k.....---- •CERTIFICATELIABILITY INSURANCE 1/0/2021 THIS CERTIFICATE IS ISSUED"AS A MATTER OFINFORMATION 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 _._ . ,... .... ._......_ . , ... . IMPORTANT:- Ifthe certificate holder is an ADDITIONAL INSURED,the policy(iet)must;haiie.ADDITIONAL.INSURED.:proViSiOrid.'or_be ericiOrneci,, If SUBROGATION1IB,WAIVED,subject to the terms and conditions-of the policy i certain policies may tiOkik:ari:erldreement:?A statement on this-certifiCatw.elOes not-conferriOhts.in thetertifiCalii.:noliier in lieu:of nucfrendorienrierit(s). "-•,;-;%.7: :1,'.. ;:',1.;,•.;:,,,„.,, .... . 1.,.-:.f,.7--r,;. ' •---'•- PRODUCER,. , . Port„ . CONTACT Kendall NAME: , ProtectoraInSuranc6'[.;LLC II:.: PHONE IFAX P.O. BOx.4669 ',, • • '.,,.., ' .., , ,.. . :,,-— ',. ,i'-i'-'''.we,'No;541',47.2191::)6 (NC.No Ext1:0541-842-29.63• Medford,OR 97504 ' -- - ' ADDRESS: kendallptAprotectorsins:corif ''• .• - ''''',' • • '‘* ' -- ' - • 1 INSURER(S)AFFORDINGCCAIERAGE '' ' . 'NAIC IP INSURERA:OhiO.Casualty Insurance • 24074' ' INSURED: GRAYB-1 INSURER B:Landmark American Insurance Co Grayback Forestry Inc PO Box.838. INSURER C. Gemini Insurance Co Merlin OR 97532-0838 INSURERD:The ciriciiinati Insurance Co 10677 .INSURER C:VOStChesfer • INSURER F,: COVERAGES CERTIFICATE NUMBER:.244759054 REVISION-NUMBER; THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE.INSOREO NAMED,ABOVE:FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQuiREmpvt,TERM oR-CONo!-rioN OF ANY CONTRACT OR OTHER. DOCOMENT'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 ANOCONDITIONS OF SUCH'POLICIES”.LIMITS SHOWN.MAY'HAVE BEEN REDUCED BY PAID CLAIMS. INSR -'. .. ADM.SUBR POLICY EFF POLICY EXP LTR TYPE OF IURNCE 4risb wvii POLICY NUMBER (MM/DO/YYYY1" (MMIDD/YYYY) 'UNITS A. X COMMERCIAL GENERAL LIABILITY Y Y' BK060388847 1/1021 1/1/2022 EACHOCCURRENCE $1,000,000 CLAIMS-MADE' XOCCUR :PREDAMAGE'MISES'(o BrEN1EDoosurrance) "1,000,000 X LBFPD ' ' " MED'EXP'(Any oneverson) $15,000 : ' ' • ' PEI2SON4&ADV INJURY $1,000,000 . r... .. Gant AGGREGATE LIMIT APPLIES PER , • ' ''' - GENERAL AGGREGATE V2,COO:* .... ls- :'''.-:• &38•Plo Tgg I I I LOC . ..,. ..... .. _ 1..,'" '- i.. . .' :- " '-'' PRODUCTS-COMP/OO.AGG1 $Z oin 000:•-• i -":•;' 0THER7-,,-:1:!-.:-.7:•7".:.,„ . . . „ . ...... LogOersBniad Forel, 11,000,000•'' --• SINGLE ""-$1,00%000'•""---•''. D, .ADTDMOISILELIADILITX„.,,,--,2,-. . ,.., t - :Yr; Y:' E8A0577453' : ' ' - 'r. . -,..0/612020'': .r5/8/2021 CEOMEgED:SI dent) _ E. .• ' •-',,- ,..! , • -.V.i,t,•:,,.: ''• •:" G71781008002 ',,,,4.1 '-:zi :. 2 ',r.s• t 1/112021 . ,.1/1/2022' , i a a — )c ANYAUTO i;lc. rr,::It.7.,vt, -g 1, r, .4 , .., 0., .„...,,,.... .,„ '.... . ,,, , , - '." ' '00:01LY*01Y.ii?tiir,09'601: $ AUTOS ONLY'., ' AUTOS' / ::, - ' ..,' : . ...!-, ..': :. , -:', ' ' " ' -; • ElooiC/INJukylEar:a6adenlj $ •.',.. :,..,:"!,.:;','"' _ I ' • •_ HIRED.',' ' • 'NON-OWNED- ,•- , - . • . , 'PROPERTY DAMAGE _ $ .AUTOS ONLY' AUTOS ONLY " ' ' : • - - - 1Per'accIdent), - , • ' - • .. X Pollution• . . ... .. . AUTO POLLUTION ' • $1,000,000 A UMBRELLA LIAB . ,X": OCCUR ES060388847 - 1/1/2021 '1/1/2022 EACH OCCURRENCE $2,000,000 • a LHA250892 111/2021 1/112022 - X EXCESS LIAB CLAIMS-MADE AGGREGATE $2,000,000 'DED RETENTIONS . 'Excess:2 $1,000,000 WORKERS COMPENSATION PER OTH- AND,EMPLOYERS'LIABILITY i,i pi STATUTE. ER ANYPROPRIETOR/PARTNER/EXECUTIVE n' Et EACH ACCIDENT $' OFFICEFUMEMBERMLUDED", N/A . • (Mandatory In NH) EL,DISEASE,EA EMPLOYEE V . If yes,descrbe under DESCRIPTION OF OPERATIONS below - 'EIL.DISEASE-POLICY LIMIT $ - - -.. C Auto Excess Liabdity GVE1002398013,000,000 1/1/200. 1/112022 Each'0Courrence DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES'(ACORD 101,Additional Remarks Schedule,niay be attachad If inoroanacn liroquIred) The.City of Ashland,Oregon,and its.elected.officials,officersand employees'as Additional insured per policy endorsement CG D4 11 (0408)as respect to Contractor's services to be provided under contract. • 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 , 1 20 East Main St Ashland OR 97520. AUTHORIZED REPRESENTATIVE •Z' ',.lig/ . I ©19884201.5 ACORD CORPORATION. All rights reserved. , ACORD 25(2016/03) The ACORD name and logo areTegistered marks of.ACORD 1 1) POLICY'NUMBER: BK06038.8847. .COMMERCIAL GENERAL LIABILITY ;Ca'2010 0.413 TH1S:ENOOR$EMENT CHANGE'S THE POLICY. PLEASE READ IT CAREFULLY,', • . . _ ADDITIONAL INIS.URED::,OWN ERS LESSEES OR , , 'CONTRACTORS SCHEDULED PERSON OR ORGANIZATION •Thia-bndorsernent modifies inturanOeproVicled,urid0r,theV.I,O.WirA: COMMERCIAL LIABILITY COVERAOBPAFT • SCHEDULE Nanie;OrAclititIori0(ipspred Person(s) „ • Organization(s) Location(s)OrtoveredOperations CITY OF ASHLAND ALL:OPERATIONS 20-EAST MAIN. STREET . ASHLAND, OR 97520 Inforrhation re:qt.:Arad tOcompletelnia SCheclble, Thot ahoWn above,Will be shown in-theMaelaratio'ns:, . „ . A Section II Who Is An Insured is amended to .B, :Withreapeet the insurance afforded to'• these -, ,• • include as an poortional.;insured the person(s):or additional insureds, the. following additional organization(s) Shown the Schedule, but'only 'exclusionsapply: with respect to liability for "bodily,injury", "property This,lopur4006,clbe§:npt apply to 'bodily injury or damage' ,or "personal and advertising 'injdrya . prpperty.darnaga ,copyrringaffer, CaOsed, inWhOle Or in Oft; by: 1. All rn6terial's. parts -or Yolk:acts'at...omissions;or equipment furnished in connection with such 2: The acts or omissions:Orthose acting on your -work on the project (other than service, behalf; Ma!lite halide or,rapaira) perfb&ed by'.or in'the performance of your ongoing operations for on, behalf of the additional insured(s) at the • the additiOnai inured('). -at the loodtitin(S) 10CPtici the,''covpr00 bP.PrOtiOtig: has .e.en de§ighated above. cor0100; or However: That OgrtiPri. of'"Y0:14 work" out of which the injury damage' arises has:been put to its 1. The insurance afforded to such additional intended use' by ,any person -or organization insured only appliesitothe extent permitted by other than,another contractor or subcontractor law;and engaged in perfoiniin'g OperatiOns for a '2. If coverage;provide.d.tothe„additional insured,is rjdricipal,aaraApart,.of the.same project.. required oy. a ocintrabt' or agreernerit; the insurance afforded to such additional insured will not be broader than that which you are required, .by the, r contract agreerhent, to provideorsuch additional'insured. C0 20 100413' 0 insurance Bentices-Offica:Inc 2012. POgel of 2' • , With respect; to tho, insurance afforded to these 2. Available under -the applicable Limits of additional -insureds, the following is, added. to Insurance shown in the:Declarations; Section HI .Limits Of Insurance: whichever is less If coverage:provided to.:the additional insured IS rentlbr$srryOtit. $6.611 :fldt. :ir0e0 the required:by,a contract or agreement the most we :applicable Limits of Insuf4rics, sbown. ih the will pay on behalf of thd,additional insured is the Declarations. amo U nt of ineuranOe'. 1. Required by the contract or agreeMentor • • • Page 2 of.2 Insurance ServicesLOffice;-Inc.; 2012CG 20 1004 13 4,\ \ g