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HomeMy WebLinkAboutInsurance Certificate: Builder Services Group, Inc. AC 0® DAT 06 I3/2025 YY) CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS o 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 10 NAME: AOn Risk Services Central, Inc. MSC# 17385 (A/C.No.E:t): (866) 283-7122 FSX (800) 363-0105 ac.No. Aon E-MAIL O PO BOX 1447 ADDRESS: _ Lincolnshire IL 60069 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Old Republic Insurance Company 24147 Builder Services Group, Inc. INSURER B: d/b/a Gale Contractor services INSURER C: A TopBuild Company 2015 Lars way INSURER D: Medford OR 97501 USA INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570113196260 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. Limits shown are as requested LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYY MMIDD/YYY LIMITS X COMMERCIAL GENERAL LIABILITY Y Y MWZY31307125 0613012UZb EACH OCCURRENCE $2,000,000 CLAIMS-MADE HtNIEU OCCUR PREMISES Ea occurrence $2,000,000 MED EXP(Any one person) $25,000 PERSONAL&ADV INJURY $2,000,000 m GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 rn X POLICY ❑PRO a LOC PRODUCTS-COMP/OPAGG $6,000,000 m JECT _ OTHER: r- r A Y Y MWTB 313070-2S 06/30/2025 06/30/2026 COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident) $7,S00,000 BODILY INJURY(Per person) 0 X ANYAUTO Z OWNED SCHEDULED BODILY INJURY(Per accident) N AUTOS ONLY AUTOS HIREDAUTOS NON-OWNED PROPERTY DAMAGE t0 w ONLY AUTOS ONLY Per accident ' t; N A X UMBRELLALIAB H OCCUR Mwzx31932025 0 30 2025 06/30/2026'EACH OCCURRENCE $2,000,000 L) EXCESS LIAB CLAIMS-MADE AGGREGATE $2,000,000 DED RETENTION A WORKERS COMPENSATION AND Y MWC 5 0 2 5 T677072026 X I PER STATUTE I OTH- EMPLOYERS'LIABILITY YIN ER ANV PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $3,OOO,OOO OFFICER/MEMBER EXCLUDED? FN N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $3,000,000 If yyes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $3,000,000-_ A Excess Workers Compensation Mwxs31557225 06/30/202S 06/30/2026 EL Each Accident $3,000,000— WA Stop Gap Only EL Disease - Policy ILL$3,000,000 SIR applies per policy ter s & condi ions EL Disease - Ea Emp $3,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) - tg [Proj: RE: Project Name: Ashland Airport] [AI: City of Ashland] is included as an Additional insured with respect to the General Liability and Automobile Liability policies as required by written contract. As required by written contract, the coverage provided by the General Liability and Automobile Liability policies to an Additional insured shall apply as Primary Insurance and any other applicable insurance coverage carried by the Additional insured shall not contribute with this insurance. A waiver of Subrogation is provided for the above referenced General Liability, Automobile Liability and workers' Compensation policies as per written contract. Should the General Liability, Automobile Liability, and/or workers Compensation policies be cancelled before the expiration date thereof, for any statutorily permitted reason other than nonpayment of CERTIFICATE HOLDER CANCELLATION ryr 0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. - g City of Ashland AUTHORIZED REPRESENTATIVE 20 East Main street B Ashland OR 97520 USA c�o�a i ���rdfc cJsLt� �G�onAtaG✓�sa g ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000065409 LOC#: A ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMEDINSURED Aon Risk Services Central, Inc. Builder Services Group, Inc. POLICY NUMBER See Certificate Number: 570113196260 CARRIER NAIC CODE See Certificate Number: 570113196260 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Additional Description of Operations/Locations/Vehicles: premium, notice of cancellation will be provided at least 30 days before the effective date of such cancellation. ACORD 101(2008/01) ©2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY INSURANCE ENDORSEMENT (TopBuild Form K) This endorsement modifies insurance provided under the following BUSINESS AUTO COVERAGE FORM As may be agreed under a separate written contract, the coverage provided by this Policy to an additional insured shall apply as primary insurance and any other insurance coverage maintained by the additional kgo insured shall be excess only and will be non-contributing with this insurance. a m N (D O m S 0 0 0 S 0 0 0 CA 672 009 0615 Page 1 of 1 MWTB 313070 25 TopBuild Corp 06/30/25-06/30/26 IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, ADDITIONAL INSURED - PRIMARY AND NONCONTRIBUTORY BASIS (TopBuild Form BB) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM It is agreed that the Commercial General Liability Coverage Form, CG 00 01 (04 13) is amended as follows: Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, item 4. Other Insurance, the following paragraph is added: d. Only if agreed under a separate written contract, executed prior to the'occurrence"for which claim is made under the policy, the coverage provided by this Policy to an Additional Insured shall apply as primary insurance, and any other applicable insurance coverage carried by the Additional Insured shall not contribute with this Insurance. GL 672 006 0625 Page 1 of 1 MWZY 313071 25 TopBuild Corp. 06/30/25-06/30/26 IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART/FORM SCHEDULE Name Of Person(s) or Organization(s): All Persons or Organizations as Required by Contract or Agreement It is agreed that the Commercial General Liability Coverage Form, CG 00 01 (04 13) is amended as follows: Under SECTION IV- COMMERCIAL GENERAL LIABILITY CONDITIONS, ITEM 8.Transfer of Rights of Recovery Against Others To Us, the following is added: In the event of any payment under this policy the company waives its right of recovery against any Person or Organization described in the above Schedule and for whom the Named Insured has agreed to waive such right of recovery in a written contract entered into prior to the date of loss, but this waiver shall apply only to such written contract with the Named Insured, and shall not be construed to be a waiver in respect to any other contracts. a rn N m O N (2 S GL 672 054 0617 Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. MWZY 313071 25 TopBuild Corp. 06/30/25-06/30/26 IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY BLANKET ADDITIONAL INSURED ENDORSEMENT (TopBuild Form N) This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM It is understood and agreed that additional insureds are persons, lessors, rental agencies and other entities required to be covered for liability under the terms of any agreement entered into by the named insured or its representatives. CA 672 001 0615 Page 1 of 1 MWTB 313070 25 TopBuild Corp. 06/30/25-06/30/26 IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM SCHEDULE Name Of Person(s) Or Organizations(s): All Persons or Organizations as Required by Contract or Agreement It is agreed that the Business Auto Coverage Forms, (CA 00 01 03 06; CA 00 01 03 10; CA 00 01 10 13) are amended as follows: Under SECTION IV - BUSINESS AUTO CONDITIONS, ITEM 5. Transfer of Rights of Recovery Against Others To Us, the following is added: In the event of any payment under this policy the company waives its right of recovery against any Person or Organization described in the above Schedule and for whom the Named Insured has agreed to waive such right of recovery in a written contract entered into prior to the date of loss, but this waiver shall apply only to such written contract with the Named Insured, and shall not be construed to be a waiver in respect to any other contracts. a 0 N 8 O CA 672 035 0617 Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. MWfB 313070 25 TopBuild Corp. 06/30/25-06/30/26 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 0313 POLICY NUMBER: MWC 315571 25 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. SCHEDULE ANY PERSON OR ORGANIZATION TO WHOM YOU HAVE AGREED TO WAIVE YOUR RIGHT OF RECOVERY IN A WRITTEN CONTRACT, PROVIDED SUCH CONTRACT WAS EXECUTED PRIOR TO THE DATE OF LOSS . DATE OF ISSUE: 06-30-25 1983 National Council on Compensation Insurance. OLD REPUBLIC INSURANCE COMPANY WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 040306 (Ed.04-84) POLICY NUMBER MWC 315571 25 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 0 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION TO ALL CALIFORNIA OPERATIONS WHOM YOU HAVE AGREED TO WAIVE YOUR RIGHT OF RECOVERY IN A WRITTEN CONTRACT PROVIDED SUCH CONTRACT WAS EXECUTED PRIOR TO THE DATE OF LOSS. a m 0 8 DATE OF ISSUE: 06-30-25 0 0 ©1998 by the Workers'Compensation Insurance Rating Bureau of Califorria. All rights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual p 1999. OLD REPUBLIC INSURANCE COMPANY WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC420304B (Ed. 6-14) TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Texas is shown in Item 3.A. of the Information Page. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule where you are required by a written contract to obtain this waiver from us. This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. The premium for this endorsement is shown in the Schedule. Schedule 1. ( ) Specific Waiver Name of person or organization (X) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: ALL TEXAS OPERATIONS 3. Premium: The premium charge for this endorsement shall be 0 percent of the premium developed on payroll in connection with work performed for the above person(s)or organization(s)arising out of the operations described. 4. Advance Premium: INCLUDED This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 06-30-2025 Policy No.MWC 315571 25 Endorsement No. Insured TOPBUILD CORP. Premium $ INCL. Insurance Company OLD REPUBLIC INSURANCE COMPANY / Countersigned By 5 WC42 03 04B (Ed. 6-14) Copyright 2014 National Council on Compensation Insurance,Inc.All Rights Reserved. OLD REPUBLIC INSURANCE COMPANY WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 430305 POLICY NUMBER MWC 315571 25 UTAH WAIVER OF SUBROGATION ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Utah is shown in Item 3.A. of the Information Page. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Our waiver of rights does not release your employees' rights against third parties and does not release our authority as trustee of claims against third parties. Schedule ANY PERSON OR ORGANIZATION TO WHOM YOU HAVE AGREED TO WAIVE YOUR RIGHT OF RECOVERY IN A WRITTEN CONTRACT PROVIDED SUCH CONTRACT WAS EXECUTED PRIOR TO THE DATE OF LOSS . a N O i[I m 8 O r O O O DATE OF ISSUE: 06-30-25 0 n 2000 National Council on Compensation Insurance,Inc. OLD REPUBLIC INSURANCE COMPANY This Endorsement forms a part of the Policy to which attached, effective on the inception date of the Policy unless otherwise stated herein. (The following information is required only when this Endorsement is issued subsequent to preparation of the Policy). INSURED TopBuild Corp. Policy No. MWXS 315572 25 Endorsement Effective 06/30/25 (12:01 A.M.) Premium, if any $ by OLD REPUBLIC INSURANCE COMPANY EXCESS INSURANCE POLICY FOR SELF -INSURER OF WORKERS COMPENSATION AND EMPLOYERS LIABILITY WAIVER OF SUBROGATION -RECOVERY FROM OTHERS ENDORSEMENT Schedule Person(s)or Organization(s): Any Person or Organization against whom you have agreed to waive your right to recover in a Written Contract provided such Contract was executed prior to the date of loss. The following is added to Part Seven -Conditions, E. Subrogation -Recovery From Others: We will not enforce any claims we assume against the Person(s)or Organization(s) named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us. This agreement shall not operate directly or indirectly to benefit any person or organization not named in the Schedule. This Endorsement will not vary, alter or extend any agreement, provision, condition or declaration of the Policy other than as stated above. EC 013(06/04) MWXS 315572 25 TopBuild Corp. 06/30/25-06/30/26 IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (TopBuild Form RR) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Name of Person or Organization: Any person or organization, not otherwise City of Ashland scheduled as an additional insured under this policy, that the Named Insured agreed to name as an additional insured in a written contract executed prior to the occurrence for which a claim is made under this policy. SECTION II—WHO IS AN INSURED is amended to include a person or organization as defined in the Schedule above. We shall indemnify the additional insured for all covered damages proximately caused by the negligently performed or negligently completed work of the Named Insured. We shall further reimburse the additional insured for reasonable and necessary attorney's fees and litigation costs incurred in defending against covered damages proximately caused by the negligently performed or negligently completed work of the Named Insured, except for those attorney's fees and litigation costs paid by another insurer. Our duty to indemnify and to reimburse attorneys' fees and litigation costs shall not exceed the product derived by multiplying the total dollar amount of liability for covered damages, or the total dollar amount of attorneys' fees and litigation cost, by that percentage of legal liability attributable to the Named Insured for covered damages as determined by a trier-of-fact in an arbitration or trial, a r> 0 G L 672 002 0615 s a Page 1 of 1 0 O 0 0 MWZY 313071 25 TopBuild Corp. 06/30/25-06/30/26 g June 2025 Dear valued customer: Enclosed please find a renewal Certificate of Insurance (COI) for the coverage year that begins on June 30, 2025. The COI is a renewal of what was provided and approved when we executed the contract. If anything still appears to be noncompliant, please refer to the executed agreement for our mutual understanding regarding insurance requirements.This COI was based on those provisions. We're excited to share that we have made some improvements to our insurance program— we have moved our excess carrier over to Old Republic and we have also added Notice of Cancellation wording to our COI. We believe these changes improve our already excellent insurance program If you are a compliance company and the certificate appears to be noncompliant, we likely agreed to revised insurance provisions as part of the contract. Compliance companies, please contact your client to obtain revised insurance provisions. If you have any questions, please contact your local branch. Thank you, Lee Carpenter Manager, Risk and General Insurance