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HomeMy WebLinkAboutCertificate of Insurance: Ryder, Michael A`oRo° CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) O1/06/2026 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: Samantha Musser Hart Insurance Agency - Medford PHONE FAX PO Box 1240 A/C No Ext: (541) 779-4232 A/C No: (541) 474-1890 E-MAIL Grants Pass OR 97528 ADDRESS: smusser@hartinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Austin Mutual Insurance Compan 13412 INSURED INSURER B Michael Ryder INSURER C: 5950 Griffin Creek Road INSURER D7 Medford OR 97501 INSURER E7 (541) 890-4040 INSURERF: COVERAGES SM CERTIFICATE NUMBER:Cert ID 31409 (2) 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MWDD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE IX I OCCUR MPJ5606P 03/15/2025 03/15/2026 PREM SESOEa occurrDence $ 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 X POLICY JECT PRO ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder is listed as additional insured where required by written contract per attached form CG7430(03/21) . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. The City of Ashland Parks & Recreation 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 Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 74 30 03 21 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS EXTENSION ENDORSEMENT (LIABILITY) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM A. Additional Insureds 2. Managers or Lessors of Premises Each of the following is added to Section 11 —Who Any manager or lessor of premises to whom Is An Insured of the Commercial General Liability you are obligated by virtue of a written "Insured Coverage Form attached to this policy, but only as Contract" to provide insurance such as is specifically described by the following: afforded by this policy, but only with respect to 1. Owners, Lessees, or Contractors liability arising out of the ownership, maintenance or use of that part of the premises Any person or organization for whom you are leased to you. performing operations is also an additional This insurance does not applyto: insured, when you and such person or organization have agreed in writing in a a. Any "occurrence" that takes place after contract or agreement that such person or you cease to be a tenant in the premises; organization be included as an additional or insured on your policy. Such person or b. Structural alterations, new construction or organization is an additional insured only with demolition operations performed by or for respect to liability for "bodily injury", "property such additional insured. damage", "personal and advertising injury" caused in whole or part, by: 3. Mortgagee, Assignee or Receiver a. Your acts or omissions; or Any person or organization as mortgagee, b. The acts or omissions of those acting on assignee or receiver, but only with respect to your behalf; liability as mortgagee, assignee or receiver and arising out of the ownership, maintenance In the performance of your ongoing operations or use of the premises by you. for the additional insured at the location This insurance does not apply to structural designated and described in the written alterations, new construction and demolition contract or agreement. operations performed by or for that person or This insurance does not apply to "bodily injury" organization. or"property damage" occurring after: 4. State or Political Subdivision—Permits a. All work, including materials, parts or Any state or political subdivision to whom you equipment furnished in connection with are obligated to provide insurance such as is such work, on the project (other than afforded by this policy, subject to the following service, maintenance or repairs) to be performed by or on behalf of the additional provisions: insured(s) at the location of the covered a. This insurance applies only with respect to operations has been completed; or operations performed by you or on your b. That portion of"your work"out of which the behalf for which the state or political injury or damage arises has been put to its subdivision has issued a permit. intended use by any person or b. This insurance does not apply to: organization other than another contractor or subcontractor engaged in performing (1) "Bodily injury", "property damage", operations for a principal as a part of the "personal and advertising injury" same project. arising out of operations performed for the state or municipality; or CG 74 30 03 21 Includes copyrighted material of ISO, Inc. with its permission Page 1 of 2 (2) "Bodily injury" or "property damage" C. Artisans Legal Liability included within the "products- The coverage and limits provided under the completed operations hazard". Commercial General Liability Coverage Form is With respect to the insurance afforded to these extended to include those professional services additional insureds, the following is added to employed by you in connection with your Section III— Limits Of Insurance: operations in your capacity as a construction If coverage provided to the additional insured is contractor. required by a contract or agreement, the most we This includes: will pay on behalf of the additional insured is the 1. Construction means, methods, techniques, amount of insurance: sequences and procedures; 1. Required by the contract or agreement; or 2. Misinterpretation or wrongful application of 2. Available under the applicable limits of designs, specification, drawings, surveys, insurance; maps, reports, opinions or change orders; and whichever is less. 3. Incidental systems or product amendment that The additional insured status provided for under is necessary for installation, service or Paragraph of this endorsement shall not increase completion of work performed by you. All the applicable limits of insurance. applicable exclusions, conditions and definitions contained in the Commercial B. Waiver of Transfer of Rights of Recovery General Liability Coverage Form shall apply to Against Others To Us this coverage. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us as contained in Section IV — Commercial General Liability Conditions of the Commercial General Liability Coverage Form attached to this policy: We waive any right of recovery against any person(s) or organization(s) as required by written contract or written agreement because of payments we make under this Coverage Part, provided the "bodily injury" or "property damage" occurs subsequent to the execution of the contract or agreement. 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. Page 2 of 2 Includes copyrighted material of ISO, Inc. with its permission CG 74 30 03 21