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Home My WebLink AboutInsurance Certificate: Cut 'N Break Construction, Inc. -' DATE(MM/DDNYYY .Ac"Ra CERTIFICATE OF LIABILITY INSURANCE 03/04/2026 1 - F - 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). CON TACI PRODUCER NAME: CLIENT CONTACT CENTER FEDERATED MUTUAL INSURANCE COMPANY PNo-R€- x- HOME OFFICE:P.O.BOX 328 IA/c,No,Ext):888 333 4949 (A/C,No):507-446-4664 OWATONNA,MN 55060 ADDRESS:CLIENTCONTACTCENTERaFEDINS.COM INSURERS AFFORDING COVERAGE NAIC it INSURER A:FEDERATED RESERVE INSURANCE COMPANY 16024 INSURED INSURER B: CUT'N BREAK CONSTRUCTION,INC. INSURER C: MEED ORD,OR 97501-0108 INSURER Ds _I INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:177 REVISION NUMBER:0 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 SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LT R INSR WVD MMfDDIYYYY MM/DDIYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE ®OCCUR DAMAGE TO RENTED PREMISES $100 UUU (Ee eeeurren Ce) MED EXP(Any one person) EXCLUDED A Y N 9829854 04/13/2026 04/13/2027 PERSONAL&ADVINJURY $1,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,OUO,000 .1 POLICY L_YE O LOC PRODUCTS&COMPIOP ACC $2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 (Ea aecident) X ANYAUTO BODILY INJURY(Per Person) A OWNED AUTOS ONLY AUT SCHOS ODILY EDULED Y N 9829854 04/13/2026 04/13/2027 B INJURY(Per Accident) HIRED AUTOS ONLY OWNEDPROPERTY DAMAGE AUTOS AUTOS ONLY (Per Accident) X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $2,000,000 A EXCESSLIAB CLAIMS-MADE Y N 9829855 04/13/2026 04/13/2027 AGGREGATE $2,000,000 DED RETENTIgV PER STATUTE I THER WORKERS COMPENSATION 'AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERI EXECUTIVE E.L EACH ACCIDENT OFFICERIMEMBER EXCLUDED? NI/A (Mandatory in NH) E.L DISEASE EA EMPLOYEE If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE POLICY LIMIT i i DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES IACORD 101,Additional Remarks Schedule,may be attached if more space is required) SEE ATTACHED PAGE CERTIFICATE HOLDER CANCELLATION CITY OF ASHLAND 177 0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 20 E MAIN ST ASHLAND,OR 97520-1814 BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE l � © 1986-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: Ac"R"fid LOG ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMEDINSURED FEDERATED MUTUAL INSURANCE COMPANY CUT'N BREAK CONSTRUCTION,INC. PO BOX 1455 POLICY NUMBER MEDFORD,OR 97501-0108 SEE CERTIFICATE#177.0 CARRIER NAIC CODE EFFECTIVE DATE-SEE CERTIFICATE#177.0 SEE CERTIFICATE#177.0 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE ADDITIONAL INSURED ALSO INCLUDES: THE CITY OF ASHLAND, ITS OFFICERS, EMPLOYEES AND AGENTS THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN A WRITTEN CONSTRUCTION AGREEMENT WITH YOU ENDORSEMENT FOR GENERAL LIABILITY. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED BY CONTRACT ENDORSEMENT FOR BUSINESS AUTO LIABILITY. INSURANCE PROVIDED BY THE GENERAL LIABILITY COVERAGE IS PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE SUBJECT TO THE CONDITIONS OF THE PRIMARY AND NONCONTRIBUTORY CLAUSE- OTHER INSURANCE CONDITION. INSURANCE PROVIDED BY THE BUSINESS AUTO LIABILITY IS PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE SUBJECT To THE CONDITIONS OF THE PRIMARY AND NONCONTRIBUTORY CLAUSE- OTHER INSURANCE CONDITION. COMMERCIAL UMBRELLA FOLLOWS FORM ACCORDING TO THE TERMS, CONDITIONS, AND ENDORSEMENTS FOUND IN THE COMMERCIAL UMBRELLA POLICY. FOR REASONS OTHER THAN NON-PAYMENT OF PREMIUM, 30 DAYS NOTICE WILL BE PROVIDED TO THE CERTIFICATE HOLDER IN THE EVENT THAT THE ISSUING COMPANY CANCELS THE POLICY BEFORE THE EXPIRATION DATE OF THE POLICY. ACORD 101 (2008101) (D 2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL AUTO CAU44511 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ��N�� U��x�� - PRIMARY ��u�� NONCONTRIBUTORY m �� N �� Q��u�� mwmm�mm nm��wnx�nu��m� ��n�� mm�*o� This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this andoromnoent, the provisions of the Coverage Form apply unless modified by the endorsement. A. The following is added to the Other |nsmnonno B. The following is added to the Other Insurance Condition in the Business Auto Coverage Form Condition in the Auto Dealers Coverage Form and and the CNhmn |mmurmmoe - Primary And Eocu*mm supersedes any provision to the contrary: Insurance Provisions in the Motor Carrier This Coverage Form'a Covered Autos Liability Coverage Form and supersedes any provision to Coverage and General Liability Coverages are the contrary: primary to and will not seek contribution from any This Coverage Fornn~s Covered Autos Liability other insurance available to an "insured" under Coverage is primary to and will not meek your policy provided that: 1 Such "insured" is u Named Insured under contribution from any other insurance available to ^ ' and an "inoured" under your policy provided that: such other insurance; 1. Such "insured" is m Named Insured under 2' You have agreed in writing in a contract or such other insurance; and agreement that this insurance would be primary and would not seek contribution from You have agreed in writing in a contract or any other insurance available to such agreement that this insurance would be "insured" primary and would not seek contribution from any other insurance available to such "insured". C |nsuo*ncn Services Office, Inc., 2016 Page 1 of CAU443V1 16 Policy Number: 082S854 Transaction Effective Date: O4/13/2O2S THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ UCAREFULLY. ADDITIONAL INSURED BY CONTRACT ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART With respect to coverage provided by this mndoraenommd, the provisions of the Coverage Form apply unless modified by the endorsement. A. WHO IS AN INSURED for"bodily injury" and "property damage" liability is amended to include: Any person or organization other than ujoint venture, for which you have agreed by written contract to procure bodily injury or property damage "auto" liability insurance arising out of operation of covered ,auto" with your permission. However, this additional insurance does not apply to: (1) The owner oranyone else from whom you hire or borrow u covered ,auto" This exception does not apply if the covered "auto" is a "trailer" connected to a covered "auto"you own. (2) Your "employee" if the covered "auto" is owned by that "employee" or a member of his or her household. (3) Someone using a covered "auto" while he or she is working in a business of selling, servicing, nepairinQ, parking or storing "autos" unless that business is yours. (4) Anyone other than your "employees", partners (if you are m partnership), members (if you are a limited liability company), or a |moaea or borrower or any of their "emp|oyees", while moving property tnor from u covered "auto,. (S) A partner (if you are a partnmrship), or member (if you are u limited liability company) for u covered ,auio" owned by him or her ora member mf his or her household. B. The coverage extended to any additional insured by this endorsement is limited to, and subject to all terms, conditions, and exclusions of the Coverage Part to which this endorsement is attached. In addition, coverage shall not exceed the terms and conditions that are required by the terms of the written agreement to add any insured, orto procure insurance. C. The limits of insurance applicable to such insurance shall be the lesser of the limits required by the agreement between the parties, or the limits provided by this policy. D. Additional exclusions. The insurance afforded to any person or organization as an insured under this endorsement does not apply: 1. To "loss" which occurs prior to the date of your contract with such person or organization; 2� To "loss" arising out of the sole negligence of any person or organization that would not be an insured except for this endorsement. 3. To "loss" for any leased or rented "auto, when the lessor or his or her agent takes possession of the leased or rented "auho" or the policy period ends, whichever occurs first. Includes copyrighted material of Insurance Services Office, Inc. with its permission. CA-F-127 (03-03) Policy Number: y82Q854 Transaction Effective Date: 04/13/2U2G 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 Condition and supersedes any provision to the or 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 @ Insurance Services Office, Inc., 2018 Page 1 of 1 CG 20 01 12 19 Policy Number: 9829854 Transaction Effective Date: 04/13/2026 COMMERCIAL GENERAL LIABILITY CG 20331218 THIS ENDORSEMENT CHANGES THE POLICY~ PLEASE READ IT CAREFULLY. �U�U�� HU��U��U� � �K�U�� U� ��mmu��n��u� .m��n�m�� m�u��x��, �.��u�~� �r"� CONTRACTORS � �0H��0��U�� NQ�� U��U� ��x� � �v�� nv�� . �*m�o��umw� �� " �� uu��~ REQUIRED �� CONSTRUCTION mxu��w��mm�� nn� �� WRITTEN w ��m� AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section |[ - Who Is An |muunod is amended to B. With respect to the insurance afforded to these include as an additional insured any person or additional insurmds, the k»||nvving 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 1' "Bodily injury", "property damage" or or agreement that such person or organization be 'personal and advertising injury" arising out of added as an additional insured on your policy. the rendering of, or the failure to render, any Such person or organization is an additional professional architecturu|, engineering or insured only with neoPoot to liability for "bodily surveying services, including: injury". "property damage" or "personal and ' advertising injury" caused, in whole orin part, by: a. The preparing, approving, or failing to prmpunoorupprove. nn�ps. mhopdruwingo. Y Your^ ' opiniono, raporto, uurveym, field orders. 2. The acts or omissions of those acting on your change orders or drawings and behalf; specifications; or in the performance of your ongoing operations for b' Suporviaory, inmpention, architectural or the additional insured. engineering activities. Hovvever, the insurance afforded to such This exclusion applies even if the claims additional insured: against any insured a||agm negligence or other 1. Only applies to the extent permitted by law; wrongdoing in the auperviwion, hiring, and emp|oymmnt, training or monitoring of others 2. Will not be broader than that which you are by that inoured, if the "occurrence" which required by the contract or agreement to caused the "bodily injury, or "property provide for such additional insured. damage", or the offense which caused the "personal and advertising iniury". involved the A peroon's or organ/zation'a status as an rendering of or the failure to render any additional insured under this endorsement ends professional architectural, engineering or when your operations for that additional insured surveying services. are completed. 9 Insurance Services Office, |no.. 2O18 Page 1of 2 CG20331218 Policy Number: 0828854 Transaction Effective Date: 04/13/2U20 2. "Bodily injury" or "property damage" C. With respect to the insurance afforded to these occurring after: additional inaureda, the following is added to a' All worh, including routeha|s, parts or Section I|| - Limits Of Insurance: equipment furnished in connection with The most we will pay on behalf ofthe additional such work, on the project (other than insured io the amount ofinsurance: service, maintenance or repairs) to be 1. Required by the contract or agreement you performed by or on behalf ofthe additional insured(s) at the location of the covered have entered into with the additional inaured� or ' operations has been completed; or 2. Available under the applicable limits of ---- b. That portion of "your work" out of which insurance the injury or damage arises has been put ' vvhiuheveria |�aa� to its intended use by any person or organization other than another contractor This endorsement shall not increase the or subcontractor engaged in performing applicable limits ofinsurance. operations for a principal as a part of the same project. Page 2of2 0 Insurance Services Office, |nc.. 2O18 CG 20 3312i8 Policy Number: 982B854 Transaction Effective Date: 04/13/2O28 171-997-0 177 # WNDHBS B5000-02-0083 #XWXWO021 XXXXXXX5# CITY OF ASHLAN 20 E Main St Ashland, OR 97520-181