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HomeMy WebLinkAboutInsurance Certificate: F.D. Thomas. Inc.A`"R" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) F5/24/2024 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 Alliant Insurance Services, Inc. NAME: PHONE FAX 1330 Post Oak BLVD 3rd fl a N 832 485-4000 A/C No): 832 485-4001 Houston TX 77056 ADDRESS: aratic.certs@alliant.com INSURED F.D. Thomas, Inc. 217 Bateman Dr Central Point, OR 97502 ARCTSLO-01 INSURER E : AFFORDING Assurance rnVFRAr%FA rFRTIFIrATF NtIMRFR- langc;Rslsa REVISION NUMBER - 10120 39462 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 SUER POLICPOLICY NUMBER MMIDDY EFF POLICMM/ DY EXP LIMITS LTR A X COMMERCIAL GENERAL LIABILITY Y EN6GL00162-241 6/1/2024 6/1/2025 EACH OCCURRENCE $3,000,000 CLAIMS -MADE l %(_ J OCCUR A AGE ToNTIED PREM SES EaEocc..n. E 1,000,000 MED EXP (Any one person) $10,000 _ PERSONAL & ADV INJURY $ 3,000,000 GEN'L GENERAL AGGREGATE $ 6,000,000 AGGREGATE LIMIT APPLIES PER: POLICY PE� L J L7] LOC PRODUCTS - COMP/OP AGG $ 6,000,000 $ OTHER A AUTOMOBILE LIABILITY EN6CA00287-241 6/1/2024 6/1/2025 COMBINED SINGLE LIMIT Ea accident $ 5,000,000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY Comp/Coll Dad $1,000 C X UMBRELLA LIAB X OCCUR 62785812 / CARCT000223 6/1/2024 6/1/2025 EACH OCCURRENCE $10,000,000 AGGREGATE $10,000,000 EXCESS UAB CLAIMS -MADE DIED I I RETENTION $ $ A A A A WORKERS COMPENSATION AND EMPLOYERS LIABILITYYIN ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBEREXCLUDED? (Mandatory in NH) NIA EN6WC00185-241 (AOS) EN6EW00002-241 (AK) EN6WC00186-241 (WI,MA) EN6WC00187-241 (FL,NJ,ME) 6/1/2024 6/1/2024 6/1/2024 6/1/2024 6/1/2025 6/1/2025 6/1/2025 6/1/2025 X I STATUTE E12H E.L. EACH ACCIDENT $2,000,000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 E.L. DISEASE - POLICY LIMIT $ 2,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below B Contractors Pollution Liability PCAB-5025014-0624 6/1/2024 6/1/2025 Per Incident Aggregate Limit $5,000,000 $5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Insurer C full name is: American International Group UK Limited See Attached... CERTIFICATE HOLDER CANCELLATION City of Ashland 20 E. Main Street Ashland OR 97520 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: ARCTSLO-01 LOC #: A`OR" ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Alliant Insurance Services, Inc. NAMED INSURED F.D. Thomas, Inc. 217 Bateman Dr Central Point, OR 97502 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE INSURER AFFORDING COVERAGE: Berkley Assurance Company NAIC#: 39462 POLICY NUMBER: PCAB-5025014-0624 EFF DATE: 06/01/2024 EXP DATE: 06/01/2025 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Professional Liability Each Claim $5,000,000 Aggregate Limit $5,000,000 FDT Job Number: 70862; FDT Job Name: City of Ashland - Effluent Launder Clarifier The City of Ashland, Oregon, its officers, agents and employees are Additional Insureds as respect to General Liability policy on a Primary and Non -Contributory basis where required per written contract, subject to the policy terms, conditions, and exclusions. Contractual Liability is included under the General Liability policy, subject to policy terms, conditions, and exclusions. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: EN6GL00162-241 COMMERCIAL GENERAL LIABILITY ECG 24 520 04 02 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT - OTHER INSURANCE (PRIMARY NONCONTRIBUTORY) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Paragraph a. Primary Insurance of 4. Other Insurance of SECTION IV COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced by the following: a. Primary Insurance This insurance is primary except when b. below applies. If this insurance is primary, our obligations are not affected unless any of the other insurance is also primary. Then, we will share with all that other insurance by the method described in c. below, except that we will not seek contribution from any party with whom you have agreed in a written contract or agreement that this insurance will be primary and noncontributory, if the written contract or agreement was made prior to the subject "occurrence" or offense. ECG 24 520 04 02 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 ❑ with its permission. POLICY NUMBER: EN6GL00162-241 COMMERCIAL GENERAL LIABILITY CG 20 1012 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED- OWNERS, LESSEES OR CONTRACTORS- SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations Blanket as required by written contract Blanket as required by written contract Information required to complete this Schedule if not shown above will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is 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. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" o r "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by o r on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2 AGENT COPY C. With respect to the insurance afforded to these 2. Available under the applicable limits of additional insureds, the following is added to insurance; Section III — Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable limits of insurance. will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contractor agreement; or Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 10 12 19 AGENT COPY POLICY NUMBER: EN6GL00162-241 COMMERCIAL GENERAL LIABILITY CG 20 37 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED- OWNERS, LESSEES OR CONTRACTORS- COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Blanket as required by written contract Blanket as required by written contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is 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. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contractor agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. CG 20 37 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 AGENT COPY Effective 6/1/2024, Arctic Slope Regional Corporation and its subsidiaries are discontinuing the issuance of paper certificates of insurance. We made this decision to coincide with current industry standards, as well as reduce paper waste to further our environmental initiatives. Certificates of insurance will now be emailed out to the address (or addresses) on file. In order to ensure that you continue to receive your certificates of insurance, please send an email to riskmanagement(a-)asrc.com and include the following information: Certificate number (Note: Located below the Insured Box). As an alternative, you can send us the electronic version of your existing certificate. Email address (or addresses) of where the certificate should be sent Corrections needed to the certificate if applicable. Thank you for your support in this initiative. Sincerely, Arctic Slope Regional Corporation Risk Management