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HomeMy WebLinkAboutInsurance Certificate: AKS Engineering & Forestry, LLC AC40R" CERTIFICATE OF LIABILITY INSURANCE F DATE(MMIDDNYYY) 10/30/2025 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 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 ON OT NAME: Adam Sinclair Zarosinski-Leavitt Ins Agency of Oregon, Inc PHONE (503)639-4220 FAx so3>e39-A4A9 A/C No Ext: AlX No Leavitt Group of Portland E-MAIL adam-sinclair@leavitt.com ADDRESS: 8705 SW Nimbus, Suite 100 INSURERS AFFORDING COVERAGE NAIC# Beaverton OR 97008 INSURER A:Cincinnati Insurance Company 10677 INSURED INSURER B:SAIF 36196 AKS Engineering & Forestry, LLC INSURER c:Everest National Insurance Company 10120 Construction Engineering Consultants INSURERD: 12965 SW Herman Road, Suite 100 INSURERE: Tualatin OR 97062-7017 INSURERF: COVERAGES CERTIFICATE NUMBER:25-26 gl/al/xs/wc/prof 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 SUER POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDDIYYYY MMIDDtYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _$ 1,000,000 A CLAIMS-MADE �OCCUR DAMAGE (RENTED 50,000 PREMISESS Ea occurrence $ X Y EPP0761266 11/1/2025 11/1/2026 MED EXP(Any one person) $ 10,000 PERSONAL &ADV INJURY $ 1,000,000 GENIAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECT PRO a LOG PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: WA Stop Gap $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident A X ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS X y ERA0761266 11/1/2025 11/l/2026 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS Per accident X UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 10,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED X RETENTION$ 0 X Y EPP0761266 11/1/2025 11/1/2026 $ WORKERS COMPENSATION X PER OH- AND EMPLOYERS'LIABILITY Y f N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? FN B N/A (Mandatory in NH) y 971949 11/1/2025 11/1/2026 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ 1,000,000 C Professional Liability AAEP000248-251 11/1/2025 11/1/2026 $5,000,000 Each claim $5,000,000 Annual Aggregate DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project: 3rd St & Lithia Way Sidewalk and ADA Ramp Replacement Contract. Certificate holder(s) are named as a/an additional insured(s) when required by written contract or written agreement, with respects to the insured operations on their behalf. Waiver of subrogation and primary and non-contributory status applies when required by written contract or written agreement per the attached form(s) . Umbrella coverage is following form general liability, automobile liability, and employers liability coverages. CERTIFICATE HOLDER CANCELLATION tami.camposs@ashland.or.us SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Attn: Tami Campos ACCORDANCE WITH THE POLICY PROVISIONS. 20 E Main Street Ashland, OR 975520 AUTHORIZED REPRESENTATIVE Adam Sinclair/ADSINC a O- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)