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HomeMy WebLinkAboutInsurance Certificate: Coleman Creek Consulting Inc (2)� 03/31/202® CERTIFICATE OF LIABILITY INSURANCE DATE A 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: Krist-i Dolmage Hart Insurance Agency - Medford PHONE FAX PO Box 1240 (A/C,No,E_xt).___(541) 779-4232 JA/C,No)__ E-MAIL Grants Pass OR 97528 ADDRESS: kdolmage@hartinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Ohio Security Insurance Co 24082 INSURED INSURER B: Admiral Insurance Company 24856 Coleman Creek Consulting Inc INSURER C 810 Leonard Street INSURERD: Ashland OR 97520 INSURER E:_ COVFRAGFS KD CERTIFICATE NUMBFR*Cart ID 31613 (62) 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. IN7R TYPE OF INSURANCE rADDL SUB WVD POLICY EFF I POLICY NUMBER MM/DDIYYW POLICY EXP MMIDD/YYYY LIMITS B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE � OCCUR FEIECC13827 03/18/2025,03/18/2026 DA AG ToTE PREMSES Eaoacurrence S 50,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- POLICY JECT E LOC x PRODUCTS - COMP/OP AGG $ 2,000,000 _ Professional Liabi,$ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident S 1 , 000 , 000 _ BODILY INJURY (Per person) A ANY AUTO BAS56324209 01/01/202501/01/2026 $ OWNED SCHEDULED R AUTOS ONLY AUTOS BODILY INJURY (Per accident) S PROPERTYDAMAGE (Per accident HIRED NON -OWNED AUTOS ONLY AUTOS ONLY S _ I $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE EXCESS LIAB CLAIMS -MADE $ DED I RETENTIONS S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N __1 ANYPROPRIETOR/PARTNER/EXECUTIVE PER OTH- STATUTE ER I_. $ E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED? N/A -- (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT _ S S DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is included as additional insured per attached forms ECC3190712, ECC3200712 which do not apply to Professional Liability part, and ECC5480317 . Project #19-170A, Asbestos Roof Survey, Briscoe School, 265 N. Main Street, Ashland OR. r`I=0TIC1rATC WnI r1FR rAMrFI I ATIr1Al SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. The City of Ashland, Oregon, its Elected Officials, Officers & Employees AUTHORIZED REPRESENTATIVE 20 E Main Street Ashland OR 97520 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 1 ro T.-I NAZI Coleman Creek Consulting, Inc. Automatic Additional Insured — Owners, Lessees or Contractors THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. In consideration of an additional premium of $Applied this endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY CONTRACTORS POLLUTION LIABILITY SCHEDULE Name of Person or Organization: Any person(s) or organization(s) whom the Named Insured agrees, in a written contract, to name as an additional insured. However, this status exists only for the project specified in that contract. The person or organization shown in this Schedule is included as an insured, but only with respect to that person's or organization's vicarious liability arising out of your ongoing operations performed for that insured. ECC-319-0712 ©2018, Freberg Environmental, Inc. Page 1 of 1 Coleman Creek Consulting, Inc. Automatic Waiver of Subrogation Endorsement THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies coverage provided under the following coverage part(s): COMMERCIAL GENERAL LIABILITY CONTRACTORS POLLUTION LIABILITY SCHEDULE Name of Person or Organization: Any person(s) or organization(s) to whom the Named Insured agrees, in a written contract, to provide a waiver of subrogation. However, this status exists only for the project specified in that contract. The Company waives any right of recovery it may have against the person or organization shown in the above Schedule because of payments the Company makes for injury or damage arising out of the insured's work done under a contract with that person or organization. The waiver applies only to the person or organization in the above Schedule. Under no circumstances shall this endorsement act to extend the policy period, change the scope of coverage or increase the Aggregate Limits of Insurance shown in the Declarations. ECC-320-0712 ©2018, Freberg Environmental, Inc. Page 1 of 1 "37, �6'q r Coleman Creek Consulting, Inc. Automatic Primary and Non -Contributory Insurance Endorsement Designated Work Or Project(s) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the Coverage Part(s) indicated below: COMMERCIAL GENERAL LIABILITY CONTRACTORS POLLUTION LIABILITY PROFESSIONAL LIABILITY SCHEDULE Name of Person or Organization: Any person(s) or organization(s) whom the Named Insured agrees, in a written contract, to provide Primary and/or Non-contributory status of this insurance. However, this status exists only for the project specified in that contract. In consideration of an additional premium of $Applied and notwithstanding anything contained in this policy to the contrary, it is hereby agreed that this policy shall be considered primary to any similar insurance held by third parties in respect to work performed by you under any written contractual agreement with such third party. It is further agreed that any other insurance which the person(s) or organization(s) named in the schedule may have is excess and non-contributory to this insurance. ECC-548-0317 © 2018, Freberg Environmental, Inc. Page 1 of 1