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HomeMy WebLinkAboutInsurance Certificate: Steri-Clean DATE(MM/DD/YYYY) A�C��"® CERTIFICATE OF LIABILITY INSURANCE 5/12/2025 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: Matthew Cowan Sandco Services Inc dba The Julian Summers Insurance Agency PHONE FAX 310 361-5630 g Y A/C,No,Ext: (A/C,No): 2629 Manhattan Ave ADDRESS: jay@sandco-ins.com Suite#270 INSURER(S)AFFORDING COVERAGE NAIC# Hermosa Beach CA 90254 INSURER A: WESTCHESTER SURPLUS LINES INS CO 10172 INSURED INSURER B: SAIF 36196 K.St.George Enterprises,LLC dba Steri-Clean WA INSURER C: 5125 95TH AVE NE INSURER D: INSURER E: LAKE STEVENS WA 98258-4158 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. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 10,000 A Y Y G4740017A 003 04/03/2025 04/03/2026 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 x POLICY ❑ECT ❑LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED F1F<UF1EF<I Y DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) x UMBRELLA LABx OCCUR EACH OCCURRENCE $ 2,000,000 E EXCESS LAB CLAIMS-MADE G48975823 001 04/03/2025 04/03/2026 AGGREGATE $ 2,000,000 DED I I RETENTION$ $ ORKERS COMPENSATION x STER OTH ATUTE ER ND EMPLOYERS'LIABILITY NY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 B FFICER/MEMBER EXCLUDED? Fy] N/A 100072964 12/16/2024 12/16/2025 Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 CPL-Per Occurrence 1,000,000 A Contractors Pollution Liability Professional Liability G4740017A 003 04/03/2025 04/03/2026 CPL-Per Aggregate 1,000,000 PL-Ea Claim 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Ashland,Oregon,along with its elected officials,officers,and employees are additional insured where required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 20 E.Main Street AUTHORIZED REPRESENTATIVE Ashland OR 97520 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 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) Location And Description Of Completed Or Organization(s) Operations As required by written contract, prior to a loss to N/A which this insurance applies 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 B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III— Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage" caused, in whole or in part, by required by a contract or agreement, the most we "your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance: performed for that additional insured and included in the "products-completed operations 1. Required by the contract or agreement; or hazard". 2. Available under the applicable Limits of However: Insurance shown in the Declarations; 1. The insurance afforded to such additional whichever is less. insured only applies to the extent permitted This endorsement shall not increase the by law; and applicable Limits of Insurance shown in the 2. If coverage provided to the additional insured Declarations. 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. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: G4740017A 003 COMMERCIAL GENERAL LIABILITY CG20101001 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided underthe following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: (1) Hoffman Corporation; (2) those persons or organizations who are the owners of real property on which you perform your work under a written contract with Hoffman Corporation, wherein such request is made prior to the commencement of operations; (3) those persons or organizations who provide architectural services under a written contract with Hoffman Corporation and who the insured is required to name as an additional insured under a written contract with Hoffman Corporation, wherein such request is made prior to the commencement of operations; and (4) those persons or organizations required to be named as an additional insured in a written contract related to projects performed for Hoffman Corporation, wherein such request is made prior to the commencement of operations (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section II — Who Is An Insured is amended to (1) All work, including materials, parts or include as an insured the person or organization equipment furnished in connection with shown in the Schedule, but only with respect to such work, on the project (other than liability arising out of your ongoing operations service, maintenance or repairs) to be performed for that insured. performed by or on behalf of the addi- B. With respect to the insurance afforded to these tional insured(s) at the site of the cov- additional insureds, the following exclusion is ered operations has been completed; added: or 2. Exclusions (2) That portion of"your work" out of which the injury or damage arises has been This insurance does not apply to "bodily inju- put to its intended use by any person ry" or"property damage" occurring after: or organization other than another con- tractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 10 01 © ISO Properties, Inc., 2000 Page 1 of 1 ❑ Westchester A ChUbb Company ADDITIONAL INSURED ENDORSEMENT — ONGOING WORK OR OPERATIONS Named Insured Endorsement Number K. St. George Enterprises,LLC dba Steri-Clean WA Policy Symbol Policy Number Policy Period Effective Date of Endorsement ECP G4740o17A 003 04/03/2025to 04/03/2026 04/03/2025 Issued By(Name of Insurance Company) Westchester Surplus Lines Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: CONTRACTORS POLLUTION LIABILITY COVERAGE PART SCHEDULE: Name of Person(s)or Organization(s):As required by written contract,prior to a loss to which this insurance applies (If no entry appears above,information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. SECTION II -WHO IS AN INSURED is amended to include as an additional insured the persons or organizations shown in the Schedule,but only with respect to liability for injury or damage, to which this insurance applies,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 insureds. 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 exclusion is added: Exclusions This insurance does not apply to injury or damage occurring after: a. All work or operations,including materials,parts or equipment furnished in connection with such work or operations, on the project (other than service, maintenance or repairs) to be performed by you or on your behalf at the site of the covered operations has been completed; or b. 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 the additional insured as a part of the same project. ENT-3250(12/18) Includes copyrighted material of Insurance Services Office,Inc.with its permission Page 1 of 2 (221012.1) Westchester A Chubb Company C. 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 contract or agreement;or z. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. All other terms and conditions of this policy remain unchanged. ENT-3250(12/18) Includes copyrighted material of Insurance Services Office,Inc.with its permission Page 2 of 2 (221012.1) Named Insured Endorsement Number K. St. George Enterprises, LLC dba Steri-Clean WA Policy Symbol Policy Number Policy Period Effective Date of Endorsement ECP G4740017A 003 04/03/2025 to 04/03/2026 04/03/2025 Issued By(Name of Insurance Company) Westchester Surplus Lines Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS POLLUTION LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: As required by written contract, prior to a loss to which this insurance applies (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or your work done under a contract with that person or organization and included in the products-completed operations hazard. This waiver applies only to the person or organization shown in the Schedule above. All other terms and conditions remain the same. ENV-3143(03-05) Includes copyrighted material of Insurance Services Office, Inc.with its permission Page 1 of 1 Westchester A ChUbb Company PRIMARY AND NONCONTRIBUTORY- OTHER INSURANCE CONDITION Named Insured Endorsement Number K. St. George Enterprises,LLC dba Steri-Clean WA Policy Symbol Policy Number Policy Period Effective Date of Endorsement ECP G4740o17A 003 04/03/2025to 04/03/2026 04/03/2025 Issued By(Name of Insurance Company) Westchester Surplus Lines Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTOR'S POLLUTION LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary and Noncontributory Insurance This policy is primary to, and will not seek contribution from, any other insurance available to an additional insured under this policy,provided that: a. The additional insured is a named insured under such other insurance; and b. You have agreed in a written contract or agreement that this insurance would: (1) act as primary insurance; and (2)would not seek contribution from any other insurance available to the additional insured. All other terms and conditions of this policy remain unchanged. ENV-3252(12-18) Includes copyrighted material of Insurance Services Office,Inc.with its permission Page 1 of 1 (266562.1) DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE F05113/2025 5:23 PM THIS CERTIFICATE IS ISSUED ASA 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 INSURERS), 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 CONTACT Berkshire Hathaway Homestate Companies Pacific Crest Services,Inc. NAME: PHONE FAC 3301 Hoyt Ave (A/C.No.Ext): A/C.No): Everett,WA 98201 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA: CONTINENTAL DIVIDE INSURANCE COMPANY 35939 K ST.GEORGE ENTERPRISES LLC INSURER B: 1165 WALLER ST SE INSURER C: INSURER D: SALEM,OR 97302 INSURER E: NSURER F: COVERAGES CERTIFICATE NUMBER: 637,072 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES Ea occurrence CLAIMS-MADE ❑OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'LAGGREGATE LIMITAPPLIES PER: PRODUCTS—COMP/OPAGG $ POLICY PRO-J LOC $ AUTOMOBILE AUTHORITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per Person) $ N/A ALL OWNED I SCHEDULED 05TRM062180-01 01/08/2025 01/08/2026 BODILY INJURY(Per accident) $ N/A A AUTOS AUTOS HIREDAUTOS NON-OWNED 11:17 AM 12:01 AM PROPERTY DAMAGE $ N/A AUTOS Per accident UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACHACCIDENT $ OFFICER/MEMBER EXCLUDED? Y/N (Mandatory in NH) F E.L.DISEASE—EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE—POLICY LIMIT $ $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Trailer interchange 05 TRM 062180-01 01/08/2025 11:17 AM to 01/08/2026 12:01 AM$20,000 limit$1,000 deductible. Comp or Stated Phys.Dam. In-Tow Cargo Year,Make,Model,VIN Collision Spec.Caus. Amount Deductible Limit Limit 2010 DODGE RAM 1500 1 D7RV1 GT7AS1 25278 Covered C 10,000 1000/1000 N/A N/A 2016 CHEVROLET SILVERADO 2500H 1 GC1 KVEG5GF1 88586 Covered C 18,000 1000/1000 N/A N/A 2025 INTERSTATE BUMPER PULL DUM 4RADU1223SN136376 Covered C 10,000 1000/1000 N/A N/A CERTIFICATE HOLDER CANCELLATION CITY OF ASHLAND SHOULDANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 1195 E MAIN ST EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. SHLAND,OR 97520 AUTHORIZED REPRESENTATIVE ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION.All rights M-5652(11/2011) The ACORD name and logo are registered marks of ACORD reserved.