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HomeMy WebLinkAboutInsurance Certificate: Modern Renovations x ° Coverage Is Provided In: Policy Number: Lib General Insurance Company of America, a stock company AZG ( 6) 68 46 87 30 MUtUil Domiciled in New Hampshire o 175 Berkeley Street, Boston, NIA 02116 Policy Period: i INSURANCE From 12/18/2025 To 1 /18/2026 12:01 am Standard Time PolicyCommon ' I at Insured Mailing Location k Named Insured & Mailing Address Agent Mailing Address & Phone No. John Stevenson DBA Modern (541)479-4975 Renovations INSURANCE LOUNGE, LLC 2191 Hill Way 1221 NE 7th St Medford, OR 97504-6219 Grants Pass, OR 97526-1423 Named Insured Is: Individual Named Insured Business Is; Carpentry In return for the payment of the premium, and subject to all the terms of this policy, we agree with you to provide the insurance as stated in this policy. SUMMARY OF COVERAGE PARTS AND CHARGES This policy consists of this Common Policy Declarations page, Common Policy Conditions, Coverage Parts ' (which consist of coverage forms and other applicable forms and endorsements, if any, issued to form a part of , them) and any other forms and endorsements issued to be part of this policy. COVERAGE PART CHARGES Business Auto $1,313.00 Total Charges for all of the above cover parts: $1,313.00 Coverage for Terrorism /s Included In the followingstates: Oregon Note: This is not a bill POLICY This section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE TATE(B)APPLICA LE AC 00 33 10 21 Business Auto Policy Base Extension OR AC 84 60 08 18 State Application of Terrorism Exclusion Endorsements OR Issue Date 10/19/2025 Authorized Representative To report a claim, call your.Agent or 1-844- 25-2467 DS 70 21 11 16 19/2025 68468730 candidateProcess 1020 MTCXFPNE Insured 00009083 Page 19 of 48 DATE(MM/DD)YYYY) CERTIFICATE OF LIABILITY INSURANCE 12/08/2025 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 NAME: Next First Insurance Agency,Inc. PHONE o ,(855)222-5919 a�No PO Box 60787 Palo Alto,CA 94306 E-MAIL ADOREss• support@nextinsurance.com INSURER(S)AFFORDING COVERAGE NAIC/ INSURER A: Next insurance US Company 16285 INSURED INSURER B• john stevenson john michael stevenson construction INSURER C: 2191 Hill Way INSURER 0: Medford,OR 97504 INSURER E INSURER F• COVERAGES CERTIFICATE NUMBER:994853206 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 POLICY NUMBER MMIDD MMID X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000.00 CLAIMS-MADE FKI OCCUR PREM SES EaENTED occurrence $100,000.00 MED EXP(Any one person) $10,000.00 A NXTj9RR3W7-00-GL 12/08/2025 12/08/2026 PERSONAL BADVINJURY $1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER- GENERALAGGREGATE $1,000,000.00 X POLICY JECOT- LOC PRODUCTS-COMP/OP AGG $1,000,000.00 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 X UMBRELLA LIAB X OCCUR NX119RR3W7-00-GL 12/08/2025 12/08/2026 EACH OCCURRENCE $2,000,000.00 A EXCESS LJAB CLAIMS-MADE AGGREGATE $2,000,000.00 DED RETENTION$ $ WORKERSCOMPENSATION PER OTH AND EMPLOYERS LIABILITY YIN N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ NIA E.L.EACH ACCIDENT $ OFFICEMMEM BER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Each Occurrence: $10,000.00 A Contractors Errors and Omissions NX7J9RR3W7-00-GL 12/08/2025 12/08/2026 Aggregate: $20,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached ff more space is required) Proof of Insurance. CERTIFICATE HOLDER CANCELLATION john Stevenson LIVE CERTIFICATE ohn michael stevenson construction SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2191 Hll Way THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Medford,OR 97504 . ,. ' ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE / ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26(2016103) The ACORD name and logo are registered marks of ACORD c3EICO 0 Important Information Here are your Policy Identification Cards We've provided two (2) cards for each vehicle on your policy. Need additional ID cards? The GEICO Mobile app is the quickest way to get additional ID cards. You can also send a copy of N your ID cards to anyone that needs them right from the app! a If your address changes, update it using the app or log in to geico.com. By keeping your information o up-to-date, you'll continue to receive important policy documents. m P9 0 " o 0 JOHN MICHAEL STEVENSON 0 0 n 0 0 0 0 0 0 0 N 0 0 0 0 0 0 0 O H O 1J 0 0 kO { >o 0 N N q Cut Along the Dotted Line Cut Along the Dotted Line -------------------------------------------------------- r_______________________________________________________- Oregon Insurance Identification Card Oregon Insurance Identification Card 1 ; 1 2011 FORD F-250 : 2011 FORD F-250 , 1 Policy Number Effective Date Expiration Date ; Policy.Number Effective Date Expiration Date 6232-83-41-65 11/15/25 05/15/26 6232-83-41-1 11/15/25 05/15/26 1 ; I I Named John Michael Stevenson Named John Michael Stevenson Insured(s) i Insured(s) 1 I Please keep this ID card in your vehicle at all times. ; Please keep this ID card in your vehicle at all times. You may be required to produce it upon demand of ; You may be required to produce it upon demand of law enforcement. GEIC0o ' law enforcement. i FOLD HERE FOLD HERE FOLD HERE FOLD HERE FOLD HERE FOLD HERE :FOLD HERE FOLD HERE FOLD HERE FOLD HERE FOLD HERE FOLD HERE I 2011 FORD F-250 ; 2011 FORD F-250 ; I I I I t I I I � I I I 1 I I � I I 1 I I I I I This policy provides coverage as prescribed by law. This policy provides coverage as prescribed by law. I I I I I I Jt_________ ___________________J