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HomeMy WebLinkAboutInsurance Certificate: Century West Engineering Corp. (2) ______.......4" • CENTWES-01 AIDDEHQANZADA '4��� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 9/29/2021 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 NAME: Alliance Insurance Group PHONE FAX 941 Oak St. (A/C,No,Ext):(541)687-4799 1(a/C,No):(541)6874718 Eugene,OR 97401 AE-MAIRESS: � ns9 P� info ailianceir com DD INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Travelers Property Casualty Co.of America 36161 INSURED INSURER B:Charter Oak Fire Insurance Company 25615 Century West Engineering Corporation INSURER C:SAIF Corporation 36196 5500 Meadows Road,Suite 250 INSURER D:Continental Casualty Company 20443 Lake Oswego,OR 97035 11I_u INSURER E: Off. lkl INSURER F: COVERAGES CERTIFICATE NUMBER: 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABIUTY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X 680-2P616310-21-47 10/1/2021 10/1/2022 PREMISES(a occE ence) $ 1,000,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE _ $ 2,000,000 POLICY X JECT X LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: Total Aggregate $ 16,000,000 B AUTOMOBILE LIABIUTY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ X ANY AUTO BA-0R004108-21-47-G 10/1/2021 10/1/2022 BODILYINJURY(Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY _ AUTOS ONLY (Per accident) $ _ $ A X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS UAB CLAIMS-MADE CUP-2P620789-21-47 10/1/2021 10/1/2022 AGGREGATE $ 5,000,000 DED X RETENTION$ 10,000 - $ • C WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'UABIUTY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 100024439 6/1/2021 6/1/2022 1,000,000 OFFICER/MgMBER EXCLUDED? - N/A - E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ D Professional Liab. AEH591913833 10/1/2021 10/1/2022 Ea Claim&Aggregate 5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) City of Ashland is included as an Additional Insured as respects to General Liability. . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City oof Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Publicity ylWorks ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main Street Ashland,OR 97520 AUTHORIZED REPRESENTATIVE I , ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD �..41 CENTWES-01 AIDDEHQANZADA '4`�o' CERTIFICATE OF LIABILITY INSURANCE DATE(M/2021 ) 9/29/2021 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 NAME: Alliance Insurance Group PHONE FAX 941 Oak St. (A/c,No,Ext):(541)687-4799 1(A/C,No):(541)687-4718 Eugene,OR 97401 E-MADDAILESS: � 9 P•info allianceins r com g R INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Travelers Property Casualty Co.of America 36161 INSURED INSURER B:Charter Oak Fire Insurance Company 25615 Century West Engineering Corporation INSURER C:SAIF Corporation 36196 5500 Meadows Road,Suite 250 INSURER D:Continental Casualty Company 20443 Lake Oswego,OR 97035 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY • EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 680-2P616310-21-47 10/1/2021 10/1/2022 DAMAGETORENTED 1,000,000 X PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JERCOT- X LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: Total Aggregate $ 16,000,000 B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ X ANY AUTO X BA-0R004108-21-47-G 10/1/2021 10/1/2022 BODILYINJURY(Perperson) $ OWNED SCHEDULED AUTOS ONLY _ AUTOS BODILY INJURY(Per accident) $ AUTOS ONLY _ NON-OWNEDUUTONPROPERTY accidentDAMAGE $ $ A X UMBRELLA UAB X OCCUREACH OCCURRENCE $ 5,000,000 EXCESS UAB CLAIMS-MADE CUP-2P620789-21-47 10/1/2021 10/1/2022 AGGREGATE $ 5,000,000 DED X RETENTION$ 10,000 $ C WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N 100024439 6/1/2021 6/1/2022 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ EXCLUDED'? OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) • E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ D Professional Liab. AEH591913833 10/1/2021 10/1/2022 Ea Claim&Aggregate 5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:Personal Servcies Agreement(Less Than$25,000)for General Engineering Services Regarding General Liability&Auto Liability,the City of Ashland,Oregon,and its elected officials,officers and employees are included as Additional Insureds on a primary basis,as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN city ACCORDANCE WITH THE POLICY PROVISIONS. Public Works Dept Attn:Contract Administrator 20 East Main Street AUTHORIZED REPRESENTATIVE Ashland,OR 97520 /.//i.i/V • ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.' The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following is added to SECTION II —WHO IS h. This insurance does not apply to "bodily AN INSURED: injury" or "property damage" caused by "your Any person or organization that you agree in a work" and included in the "products- "written contract requiring insurance"to include as completed operations hazard" unless the an additional insured on this Coverage Part, but: "written contract requiring insurance" specifically requires you to provide such a. Only with respect to liability for "bodily injury", coverage for that additional insured, and then "property damage" or"personal injury"; and the insurance provided to the additional b. If, and only to the extent that, the injury or insured applies only to such "bodily injury" or damage is caused by acts or omissions of "property damage" that occurs before the end you or your subcontractor in the performance of the period of time for which the "written of "your work" to which the "written contract contract requiring insurance" requires you to requiring insurance" applies, or in connection provide such coverage or the end of the with premises owned by or rented to you. policy period,whichever is earlier. The person or organization'does not qualify as an . 2. The following is added to Paragraph 4.a. of additional insured: SECTION IV — COMMERCIAL GENERAL c. With respect to the independent acts or LIABILITY CONDITIONS: omissions of such person or organization; or The insurance provided to the additional insured d. For "bodily injury", "property damage" or is excess over any valid and collectible other "personal injury" for which such person or insurance, whether primary, excess, contingent or organization has assumed liability in a on any other basis, that is available to the additional insured for a loss we cover. However, if contract or agreement. you specifically agree in the "written contract The insurance provided to such additional insured requiring insurance" that this insurance provided is limited as follows: to the additional insured under this Coverage Part e. This insurance does not apply on any basis to must apply on a primary basis or a primary and non-contributory basis, this insurance is primary any person or organization for which to other insurance available to the additional coverage as an additional insured specifically is added by another endorsement to this insured which covers that person or organizations Coverage Part. as a named insured for such loss, and we will not share with the other insurance, provided that: f. This insurance does not apply to the (1) The "bodily injury" or "property damage" for rendering of or failure to render any which coverage is sought occurs; and "professional services". g. In the event that the Limits of Insurance of the (2) The "personal injury" for which coverage is sought arises out of an offense committed; Coverage Part shown in the Declarations exceed the limits of liability required by the after you have signed that "written contract "written contract requiring insurance", the requiring insurance". But this insurance provided insurance provided to the additional insured to the additional insured still is excess over valid shall be limited to the limits of liability required and collectible other insurance, whether primary, by that "written contract requiring insurance". excess, contingent or on any other basis, that is This endorsement does not increase the available to the additional insured when that limits of insurance described in Section III — person or organization is an additional insured Limits Of Insurance. under any other insurance. CG D3 81 09 15 ©2015 The Travelers Indemnity Company.All rights reserved. Page 1 of 2 Includes the copyrighted material of Insurance Services Office, Inc.,with its permission COMMERCIAL GENERAL LIABILITY 3. The following is added to Paragraph 8., Transfer 4. The following definition is added to the Of Rights Of Recovery Against Others To Us, . DEFINITIONS Section: of SECTION IV COMMERCIAL GENERAL "Written contract requiring insurance" means that LIABILITY CONDITIONS: part of any written contract under whichyou are We waive any right of recovery we may have required to include a person or organization as an against any person or organization because of additional insured on this Coverage Part, payments we make for "bodily injury", "property provided that the "bodily injury" and "property damage" or "personal injury" arising out of "your damage" occurs and the "personal injury" is work" performed by you, or on your behalf, done caused by an offense committed: under a"written contract requiring insurance" with that person or organization. We waive this right a. After you have signed that written contract; only where you have agreed to do so as part of 'b. While that part of the written contract is in the "written contract requiring insurance" with effect; and such person or organization signed by you before, and in effect when, the "bodily injury" or c. Before the end of the policy period. "property damage" occurs, or the"personal injury" offense is committed. Page 2 of 2 ©2015 The Travelers Indemnity Company.All rights reserved. CG D3 81 09 15 Includes the copyrighted material of Insurance Services Office,Inc.,with its permission