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HomeMy WebLinkAboutInsurance Certificate: David Evans and Associates, Inc. DATE(MM/DD/YYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE 12/1/2026 3/13/2026 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 INSURERS), 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 Lockton Companies,LLC CONTACT NAME: DBA Lockton Insurance Brokers,LLC in CA PHONE FAX CA license#OF15767 A/C Ext: A/C No E-MAIL 444 W.47th St.,Ste.900 ADDRESS. Kansas City MO 64112-1906 INSURER(S)AFFORDING COVERAGE NAIC# (816)960-9000 kcasu@lockton.com INSURER A:American Zurich Insurance Company 40142 INSURED DAVID EVANS AND ASSOCIATES,INC. INSURER B:Zurich American Insurance Company 16535 1335180 2100 S RIVER PARKWAY,SUITE 100 INSURER C:American Guarantee and Liab.Ins. Co. 26247 PORTLAND OR 97201 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 23146028 REVISION NUMBER: xXXxGGGx 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 MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY Y N GL09830389 12/1/2025 12/1/2026 EACH OCCURRENCE $ 1,000,000 AMAIE To RENTED , , CLAIMS-MADE 1XI OCCUR PREM SES(E.occurrence) ccurrrence) $ 1 000 000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 � POLICY I Ak ECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ C AUTOMOBILE LIABILITY Y N BAP9830390 12/1/2025 12/1/2026 COMBINED SINGLE LIMIT $ Ea accident 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ XXX� � AUTOS ONLY AUTOS ONLY Per accident $ xxxxx x B UMBRELLA LIAB X OCCUR Y N SXS 6468058 12/1/2025 12/1/2026 EACH OCCURRENCE $ 3,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 3,000,000 DED RETENTION$ $ xxxXx x BWORKERS COMPENSATION XT WC9336626 12/1/2025 12/1/2026 X STATUTE EPERORH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N N/A E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:PROJECT NAME:HOSLER DAM MOSS REMOVAL.THE CITY OF ASHLAND,OREGON,ALONG WITH ITS ELECTED OFFICIALS,OFFICERS,AND EMPLOYEES ARE ADDITIONAL INSUREDS ON GENERAL LIABILITY,AUTO LIABILITY,AND UMBRELLA/EXCESS LIABILITY,ON A PRIMARY,NON- CONTRIBUTORY BASIS,IF REQUIRED BY WRITTEN CONTRACT AND SUBJECT TO THE TERMS AND CONDITIONS OF THE POLICY. CERTIFICATE HOLDER CANCELLATION See Attachments SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 028 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 23146 CITY 02 ASHLAND ACCORDANCE WITH THE POLICY PROVISIONS. 20 EAST MAIN STREET ASHLAND OR 97520 AUTHORIZED REPRESENTATIV7... / @ 1988 015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Miscellaneous Attachment: M503337 Certificate ID: 23146028 Additional Insured — Owners, Lessees Or Contractors — Scheduled Person Or Organization POLICY NO. GLO 9830389 This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location(s) Of Covered Operations Any person or organization you are required to add Any Location where you have agreed, through a written contract, agreement or permit, to provide as an additional insured in a written contract or Additional insured coverage except where such written agreement. Contract or agreement is prohibited by law. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule of this endorsement, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated in such Schedule. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to"bodily injury"or"property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. All other terms, conditions, provisions and exclusions of this policy remain the same. U-GL-2169-A CW(02/19) Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Miscellaneous Attachment: M503356 Certificate ID: 23146028 Additional Insured — Owners, Lessees Or Contractors — Completed Operations POLICY NO. GLO 9830389 This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Operations Or Organization(s): Any person or organization you are required to add Any location or project where you are required to provide additional insured status in a written contract or written as an additional insured under a written contract or agreement, except where such contract or agreement is written agreement. prohibited by law. Section II —Who Is An Insured is amended to include as an additional insured the person(s)or organization(s) shown in the Schedule of this endorsement, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in such Schedule, performed for that additional insured and included in the"products-completed operations hazard". All other terms, conditions, provisions and exclusions of this policy remain the same. U-GL-2168-A CW(02/19) Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Miscellaneous Attachment: M503490 Certificate ID: 23146028 POLICY NUMBER: GL09830389 Effective Date: 12/01/2025 - 12/01/2026 Other Insurance Amendment - Primary And ZL�TR�CH Non-Contributory This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part 1. The following paragraph is added to the Other Insurance Condition of Section IV - Commercial General Liability Conditions: This insurance is primary insurance to and will not seek contribution from any other insurance available to an additional insured under this policy provided that: a. The additional insured is a Named Insured under such other insurance; and b. You are required by a written contract or written agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. 2. The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition of Section IV - Commercial General Liability Conditions: This insurance is excess over: Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional insured, in which the additional insured on our policy is also covered as an additional insured on another policy providing coverage for the same 'occurrence", offense, claim or "suit". This provision does not apply to any policy in which the additional insured is a Named Insured on such other policy and where our policy is required by written contract or written agreement to provide coverage to the additional insured on a primary and non-contributory basis. All other terms and conditions of this policy remain unchanged. U-GL-1327-B CW Miscellaneous Attachment: M503408 Certificate ID: 23146028 POLICY NUMBER: BAP 9830390 Effective Date: 12/01/2025 - 12/01/2026 COMMERCIAL AUTO CA20481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE 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 endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s)who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: David Evans and Associates, Inc. SCHEDULE Name Of Person(s) Or Organization(s): Any person or organization you are required to provide additional insured status on a primary basis, in a written contract or agreement, except where such contract or agreement is prohibited by law. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II - Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I - Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1