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HomeMy WebLinkAboutInsurance Certificate: Ibarra, Moises & Valerie DBA Ibarra Industrial Services DATE(MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 11/25/2025 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 Kara Yowell NAME: Shaw Insurance Services A/cNN. Ext: (530)365-2576 a/c,No): (530)365-2576 P O Box 729 E-MAIL kara@shawinsservices.com ADDRESS: 2275 North Street INSURER(S)AFFORDING COVERAGE NAIC# Anderson CA 96007 INSURERA: SCOTTSDALE INSURANCE COMPANY 41297 INSURED INSURER B MOISES&VALERIE IBARRA,DBA:IBARRA INDUSTRIAL INSURER C: SERVICES INSURER D 20258 RIVER VALLEY DR. INSURER E: ANDERSON CA 96007 INSURER F: COVERAGES CERTIFICATE NUMBER: CL25112511456 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 POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FX OCCUR PREM SDAMAGES Ea oNcurDrence $ 50,000 MED EXP(Any one person) $ EXCLUDED A Y PSS1000617 11/21/2025 11/21/2026 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ❑ PRO ❑ LOC PRODUCTS-COMP/OPAGG $ 100,000 JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accide nt) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ElN/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City of Ashland,Oregon,its elected officials,officers,and employees are included as Blanket Additional Insured with Primary Non-Contributory applied when required by written contract with respect to General Liability,per the attached forms. Certificate of Insurance Disclaimer for Our Clients and Cert Holders:The certificate of insurance provided is a summary of coverage at the time issued.No agent remarks or wording can change policy provisions or scope of coverage provided by the policies.Policies do not fully cover all liability assigned through indemnity agreements within contracts so we recommend an attorney thorough review all contracts signed.Insurance never fully covers"contractual liability assumed within a contract".Certificates cannot be issued on future policies for past projects.If your contract requires coverage into the future we will need to 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 ST AUTHORIZED REPRESENTATIVE ASHLAND OR 97520 }A,tII3.-Q,t(yQR.. @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 00011468 LOC#: ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED Shaw Insurance Services MOISES&VALERIE IBARRA,DBA:IBARRA INDUSTRIAL SERVICES POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance quote a project specific policy for that contract.Policies cancel and notify certificate holders only in accordance with policy provisions. When in doubt,please have your clients review your FULL insurance policies to confirm you meet their contractual requirements. ACORD 101 (2008/01) © 2008ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG20331219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN A WRITTEN CONSTRUCTION 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 or additional insureds, the following additional organization for whom you are performing exclusions apply: operations when you and such person or This insurance does not apply to: organization have agreed in writing in a contract or agreement that such person or organization be 1. "Bodily injury", "property damage" or "personal added as an additional insured on your policy. and advertising injury" arising out of the Such person or organization is an additional rendering of, or the failure to render, any insured only with respect to liability for "bodily professional architectural, engineering or injury", "property damage" or "personal and surveying services, including: advertising injury" caused, in whole or in part, by: a. The preparing, approving, or failing to 1. Your acts or omissions; or prepare or approve, maps, shop drawings, 2. The acts or omissions of those acting on your opinions, reports, surveys, field orders, behalf; change orders or drawings and specifications; or in the performance of your ongoing operations for b. Supervisory, inspection, architectural or the additional insured. engineering activities. However, the insurance afforded to such This exclusion applies even if the claims additional insured: against any insured allege negligence or other 1. Only applies to the extent permitted by law; wrongdoing in the supervision, hiring, and employment, training or monitoring of others by 2. Will not be broader than that which you are that insured, if the "occurrence" which caused required by the contract or agreement to the "bodily injury" or "property damage", or the provide for such additional insured. offense which caused the "personal and advertising injury", involved the rendering of or A person's or organization's status as an the failure to render any professional additional insured under this endorsement ends architectural, engineering or surveying when your operations for that additional insured services. are completed. CG 20 33 12 19 ©Insurance Services Office, Inc., 2018 Page 1 of 2 2. "Bodily injury" or "property damage" occurring C. With respect to the insurance afforded to these after: additional insureds, the following is added to a. All work, including materials, parts or Section III—Limits Of Insurance: equipment furnished in connection with The most we will pay on behalf of the additional such work, on the project (other than insured is the amount of insurance: service, maintenance or repairs) to be 1. Required by the contract or agreement you performed by or on behalf of the additional have entered into with the additional insured; insured(s) at the location of the covered or operations has been completed; or b. That portion of"your work" out of which the 2. Available under the applicable limits of insurance; injury or damage arises has been put to its intended use by any person or organization whichever is less. other than another contractor or This endorsement shall not increase the subcontractor engaged in performing applicable limits of insurance. operations for a principal as a part of the same project. Page 2 of 2 ©Insurance Services Office, Inc., 2018 CG 20 33 12 19 COMMERCIAL GENERAL LIABILITY CG20391219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN WRITTEN CONSTRUCTION AGREEMENT WITH YOU (COMPLETED OPERATIONS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to 2. Supervisory, inspection, architectural or include as an additional insured any person or engineering activities. organization for whom you have performed This exclusion applies even if the claims against operations when you and such person or any insured allege negligence or other wrongdoing organization have agreed in writing in a contract or in the supervision, hiring, employment, training or agreement that such person or organization be monitoring of others by that insured, if the added as an additional insured on your policy. Such "occurrence" which caused the "bodily injury" or person or organization is an additional insured only "property damage" involved the rendering of or the with respect to liability for"bodily injury"or"property failure to render any professional architectural, damage"caused, in whole or in part, by"your work" engineering or surveying services. performed for that additional insured and included in the "products-completed operations hazard". C. With respect to the insurance afforded to these However,the insurance afforded to such additional additional insureds, the following is added toSection III — Limits Of Insurance: insured: 1. Only applies to the extent permitted by law; and The most we will pay on behalf of the additionalinsured is the amount of insurance: 2. Will not be broader than that which you are 1. Required by the contractor agreement you have required by the contractor agreement to provide entered into with the additional insured; or for such additional insured. B. With respect to the insurance afforded to these 2. Available under the applicable limits of additional insureds, the following additional insurance; exclusion applies: whichever is less. This insurance does not apply to: This endorsement shall not increase the applicable "Bodily injury" or "property damage" arising out of limits of insurance. the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: 1. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or CG 20 39 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 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 additional insured. This insurance is primary to and will not seek 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 ©Insurance Services Office, Inc., 2018 Page 1 of 1