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HomeMy WebLinkAboutInsurance Certificate: One Way Trigger, LLC, Northwest Paving, Inc. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/4/2/2025 Y) 025 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 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 CONTAUI NAME: Luke Hagarty Reliable Risk Management, LLC A/CNN. Ext: (480)813-3415 TF AX No: 42104 N Venture Dr E-MAIL Luke@reliableriskmanagement.com ADDRESS: Suite D122 INSURER(S) AFFORDING COVERAGE NAIC# Anthem AZ 85086 INSURERA:Alaska National Insurance Co. 38733 INSURED INSURER B:Pacific Compensation Insurance Company 11555 One Way Trigger, LLC, Northwest Paving, Inc INSURER C:Argonaut Insurance Company 19801 5960 S LAND PARK DR #250 INSURER D:Evanston Insurance Company 35378 INSURER E Sacramento CA 95822 INSURER F: COVERAGES CERTIFICATE NUMBER:CL2412510150 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DDNYYY MM/DDNYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE ❑X OCCUR DAMAGETORENTED 500,000 PREMISES Ea occurrence $ X Y 24L LS 12941 12/1/2024 12/1/2025 MED EXP(Any one person) $ 15,000 PERSONAL &ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 LOC PRODUCTS-COMP/OPAGG $POLICY ❑XPRO 2,000,000 JECT OTHER: Employee Benefits $ 2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident A X ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED X Y 24L AS 12941 12/1/2024 12/1/2025 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS Per accident X UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 3,000,000 A EXCESS LAB CLAIMS-MADE AGGREGATE $ 3,000,000 DED X RETENTION $ 10,000 X Y 24L LU 12941 12/1/2024 12/1/2025 $ g WORKERS COMPENSATION WC1040582 X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A C (Mandatory in NH) y WC92 9178 8 27 914 (OR, WA) 12/1/2024 12/1/2025 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 A Leased/Rented Equipment 24L IA 12941 12/1/2024 12/1/2025 Limit 500,000 D Pollution Insurance CPLMOL129134 2/5/2025 2/5/2026 Limit(Aggregate/Occurrence) 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) The City, and its agents, officers, and employees are additional insureds on a Primary & Non-Contributory basis, a Waiver of Subrogation applies in favor of the Additional Insureds as required by a written contract; attached endorsements. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The City of Ashland THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 20 East Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE John Norbut/LUKE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)