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HomeMy WebLinkAboutInsurance Certificate: Stoddard Power Systems, LLC '47C)R" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 8/20/2025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. T CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLIC BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORI[ 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 HUB International Northwest, LLC NAME: Angela San I PHONE PO Box 10167 A/C,No E •541-687-1117 ac No):541-342-8280 Eugene OR 97440 ADDRESS: an ela.san I hubintemational.com INSURERS AFFORDING COVERAGE NAIC N INSURERA.Underwriters at Lloyd's London 15792 INSURED STODPOW-01 INSURERS:Berkley Assurance Company 39462 Stoddard Power Systems, LLC 1600 Valley River Dr., Suite 380 INSURERC: Eugene OR 97401 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1837709842 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 J=WVD POLICY NUMBER MM/DD/YYYY MM/DD LIMITS B X COMMERCIAL GENERAL LIABILITY Y Y VUMA0323992 8/21/2025 8/21/2026 EACH OCCURRENCE $1,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY I JECOT- �LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: Hired Non owned Auto $InClUded AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? ❑ N/A E.L.EACH ACCIDENT $ Mandatory in NH) (f yes,describe under E.L.DISEASE-EA EMPLOYEE $ I DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Professional Liability-E&O Y Y ANE4774988.25 7/23/2025 7/23/2026 Limit: 1,000,000 Deductible: 2,500 Retroactive Date: 07/23/2021 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder and all entities required by written contract are included as additional insureds on a primary and non-contributory basis with waiver of subrogation as respects to the general liability including completed operations and professional liability as required by written contract per attached endorsements.Subject to policy limits,terms,conditions and exclusions. Hired and Non-Owned Auto coverage is included on the General Liability policy and coverage forms extend. Additional Insureds Include: City of Ashland, Oregon,and its elected officials,officers and employees 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 East Main Street Ashland OR 97520 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 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: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anization s : Locations Of Covered Operations As required by written contract executed and As designated in written contract with the Named signed by all parties prior to the date of loss but Insured. only to the extent permitted by law. 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. 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 additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage"occurring after: caused, in whole or in part, by: 1. Your acts or omissions; or 1. All work, including materials, parts or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. 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 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 ❑ 1, THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. KI ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organ ization s : Location And Description Of Completed Operations As required by written contract executed prior Construction project sites at which you performed work to the date of occurrence but only to the extent for such additional insured. permitted by law and 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. Information required to complete this Schedule, if not shown above,will be shown in the Declarations. 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". CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 0 0:A COMMERCIAL GENERAL LIABILITY CG 20 34 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - LESSOR OF LEASED EQUIPMENT - AUTOMATIC STATUS WHEN REQUIRED IN LEASE AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured any person(s) or additional insureds, this insurance does not apply organization(s) from whom you lease equipment to any "occurrence" which takes place after the when you and such person(s) or organization(s) equipment lease expires. have agreed in writing in a contract or agreement C. With respect to the insurance afforded to these that such person(s) or organization(s) be added as additional insureds, the following is added to an additional insured on your policy. Such Section III—Limits Of Insurance: person(s)or organization(s)is an insured only with respect to liability for "bodily injury", "property The most we will pay on behalf of the additional damage" or "personal and advertising injury" insured is the amount of insurance: caused, in whole or in part, by your maintenance, 1. Required by the contract or agreement you operation or use of equipment leased to you by have entered into with the additional insured; such person(s)or organization(s). or However, the insurance afforded to such 2. Available under the applicable limits of additional insured: insurance; 1. Only applies to the extent permitted by law; whichever is less. and This endorsement shall not increase the 2. Will not be broader than that which you are applicable limits of insurance. required by the contract or agreement to provide for such additional insured. A person's or organization's status as an additional insured under this endorsement ends when their contract or agreement with you for such leased equipment ends. CG 20 34 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 20 11 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designation Of Premises (Part Leased To You): Name Of Person(s)Or Organization(s)(Additional Insured): As required by written contract executed and signed by all parties prior to the date of loss but only to the extent permitted by law. 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. Additional Premium: $ 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 2. If coverage provided to the additional insured is include as an additional insured the person(s) or required by a contract or agreement, the organization(s) shown in the Schedule, but only insurance afforded to such additional insured with respect to liability for "bodily injury", "property will not be broader than that which you are damage" or "personal and advertising injury" required by the contract or agreement to caused, in whole or in part, by you or those acting provide for such additional insured. on your behalf in connection with the ownership, B. With respect to the insurance afforded to these maintenance or use of that part of the premises additional insureds, the following is added to leased to you and shown in the Schedule and Section III—Limits Of Insurance: subject to the following additional exclusions: This insurance does not apply to: If coverage provided to the additional insured is required by a contract or agreement, the most we 1. Any 'occurrence" which takes place after you will pay on behalf of the additional insured is the cease to be a tenant in that premises. amount of insurance: 2. Structural alterations, new construction or 1. Required by the contract or agreement; or demolition operations performed by or on b 2. Available under the applicable limits of behalf of the person(s) or organization(s) insurance; shown in the Schedule. However: whichever is less. 1. The insurance afforded to such additional This endorsement shall not increase the applicable limits of insurance. insured only applies to the extent permitted by law; and CG 20 11 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 U16 COMMERCIAL GENERAL LIABILITY CG 20 01 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the This insurance is primary to and will not seek additional insured. contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 12 19 9 Insurance Services Office, Inc., 2018 Page 1 of 1 �•x COMMERCIAL GENERAL LIABILITY ' CG 24 04 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s) Or Organization(s): Any person or organization to whom or to which you are obligated by virtue of a written contract to waive your right of recovery. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. CG 24 04 12 19 ©Insurance Services Office, Inc., 2018 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ,;x DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT WITH A CAP This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Designated Construction Projects: Construction project sites at which you perform work for additional insureds that require you to obtain per project general aggregate limits under a written contract that was executed prior to the date of any 'occurrence" covered under this policy. Maximum Aggregate Limit: $5,000,000 A. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE LIABILITY and for all medical expenses caused by accidents under COVERAGE C - MEDICAL PAYMENTS, which can be attributed only to ongoing operations at a single designated construction project shown in the SCHEDULE above: 1. Subject to the Maximum Aggregate Limit shown in the SCHEDULE above, a separate Designated Construction Project General Aggregate limit applies to each designated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, except damages because of"bodily injury" or "property damage" included in the "products-completed operations hazard", and for medical expenses under Coverage C regardless of the number of: a. insureds; b. claims made or"suits" brought; or c. persons or organizations making claims or bringing "suits". 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Designated Construction Project Aggregate Limit for that designated construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Designated Construction Project General Aggregate Limit for any other designated construction project shown in the SCHEDULE above. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented VCAS 20 36 04 25 Includes copyrighted information of Insurance Services Page 1 of 2 Office, Inc. with its permission. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ,•ti To You and Medical Expenses continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Construction Project General Aggregate Limit. B. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Coverage A and for all medical expenses caused by accidents under Coverage C, which cannot be attributed only to ongoing operations at a single designated construction project shown in the SCHEDULE above: 1. any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products-Completed Operations Aggregate Limit, whichever is applicable; and 2. such payments shall not reduce any Designated Construction Project General Aggregate Limit. C. Any payments made under the General Aggregate Limit or Designated Construction Project General Aggregate Limit will reduce the Maximum Aggregate Limit shown in the SCHEDULE above. D. When coverage for liability arising out of the "products-completed operations hazard" is provided, any payments for damages because of"bodily injury"or"property damage" included in the "products-completed operations hazard" will reduce the Products-Completed Operations Aggregate Limit, and not reduce the General Aggregate Limit, the Maximum Aggregate Limit nor the Designated Construction Project General Aggregate Limit. E. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. F. The provisions of SECTION III - LIMITS OF INSURANCE not otherwise modified by this endorsement shall continue to apply as stipulated. All other terms and conditions of this policy remain unchanged. VCAS 20 36 04 25 Includes copyrighted information of Insurance Services Page 2 of 2 Office, Inc. with its permission.