Loading...
HomeMy WebLinkAboutInsurance Certificate: Carlson Construction DATE(MMIDDtYYYY) A CERTIFICATE OF LIABILITY INSURANCE 08/1112026 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(les) must have ADDITIONAL INSURED provisions orbe 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). CURTACT PRODUCER NAME: CLIENT CONTACT CENTER FEDERATED MUTUAL INSURANCE COMPANY P HOME OFFICE:P.O.80X 328 1Atc,No,Ext):888-333-4949 (A/C,No):507-446 4664 OWATONNA,MN 55060 E-MAIL AooREss:CLIENTCONTACTCENTERQFEDINS.COM INSURERS AFFORDING COVERAGE NAIC# INSURER A:FEDERATED RESERVE INSURANCE COMPANY 16024 INSURED INSURER B: CARLSON CONSTRUCTION INSURER C: PO BOX 1503 INSURER D: MEDFORD,OR 97501-0112 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:8 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. IITR ADDL SUBR POLICY NUMBER POLICY Ell POLICY EXP LIMITS TYPE OF INSURANCE IN SR WVD MMtDD/YYYY MM7DDiYYYY EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY — DAMAGE TO RENTED PREMISES $100,000 CLAIMS-MADE .00CUR (Ea occurrence MED EXP(Any one person) EXCLUDED A Y N 9837473 10/06/2026 10l0612027 PERSONAL&ADVINJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY 7 n_ECT ❑LOC PRODUCTS&COMPtOP ACC $2,000,000 OTHER: COMBINED SINGLE LIMIT $1,000,000 AUTOMOBILE LIABILITY (Ea.-;dent} BODILY INJURY(Per Person) X ANYAUTO A OWNED AUTOS ONLY SCHEDULED Y N 9837473 1010612D26 10/06/2027 BODILY INJURY(Per Accident) AUTOS PROPERTY DAMAGE HIRED AUTOS ONLY NON-OWNED Per AAUTOSccident EACH OCCURRENCE $5,000,000 X UMBRELLA LIAB X OCCUR A EXCESS LIAR CLAIMS-MADE Y N 9837474 10lO6t2026 10lD612D27 AGGREGATE $5,DD0,000 DED RETENTION ANY PR OP RIETORtPARTNERI EXECUTIVE PER STATUTE THER OFFICER/MEMBER EXCLUDED? YtN E.L EACH ACCIDENT (Mandatory in NH) If yes,describe under NIA E.L DISEASEER EMPLOYEE DESCRIPTION OF OPERATIONS below E.L DISEASE POLICY LIMIT ' DESCRIPTION OF OPERATIONS t LOCATIONS I VEHICLES(AGORD 101,Additional Remarks Smut.. may be attached if more space is required) SEE ATTACHED PAGE CERTIFICATE HOLDER CANCELLATION CITY OF ASHLAND 80 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 20 E MAIN ST BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ASHLAND,OR 97520-1814 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE p� © 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD " A a AGENCY CUSTOMER ID: AC"RO LOC#: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 [SEE CY =NAMEDERATED MUTUAL INSURANCE COMPANY NSTRUCTION Y NUMBER 97501-0112 CERTIFICATE#8.4 IER NAIC CODE EFFECTIVE DATE:SEE CERTIFICATE#8.0 CERTIFICATE#&0 ADDITIONAL REMARKS -- THIS ADDITIONAL REMARKS FOR�ISA CHEDULE TO ACORD FORM, FORM NUMBER: 25M TITLE: CERTIFICATE OF LIABILITY INSURANCE THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN 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. COMMERCIAL UMBRELLA FOLLOWS FORM ACCORDING TO THE TERMS, CONDITIONS, AND ENDORSEMENTS FOUND IN THE COMMERCIAL UMBRELLA POLICY. ACORD 101(2008101) O 2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ 0[CAREFULLY. ADDITIONAL INSURED BY CONTRACT ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART With respect to coverage provided by this ondoruennent, 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: i mti n other than e joint wanture for which you have agreed by written contract to procure bodily injury orpropw�y ornoge Any person nrorQa»� o d "a o"auto" liability insurance arising out ofoperation of covered � "auto"with your permission. However,this additional insurance does not apply to: (1) The owner pranyone else from whom you hire or borrow a 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 u member of his or her household. (3) Someone using u covered "auto" while he or she is working in a business of selling, servicing, repairing, parking or storing "outna" unless that business imyours. (4) Anyone` other than your "employees", partners (if you are a partnership), members (if you are a lessee or or| borrower or any of their "�rnp|oy��u" while moving limited liability company), or a . property to or from m covered "auto". (5) A partner (if you are m pertnorahip), or u member (if you are a limited liability company) for u covered "auto" owned by him or her oro member ofhis or her household. B. The coverage extended to any additional insured by this endorsement is limited to, and subject to all hennu. � .oonditiono and exclusions of the Coverage Part to which this endorsement is attached.. � � In odditiun, coverage shall not exceed the terms and conditions that are required by the terms of the written � agreement to add any insured, nrtu procure insurance. � C. The limits of insurance applicable to such insurance shall be the |meuer 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 "|ous" for any leased or rented "auto" when the |aaoor or his or her agent takes possession of the � leased or rented "auto"nr the policy period ends, whichever occurs first. � � � � � Includes copyrighted material of Insurance Services Office, Inc. with its permission. � Policy Number: 9837473 Transaction Effective Date: 1O/08/2U26 � COMMERCIAL GENERAL LIABILITY CG 20 331219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ��U�U�N`�H����N UU���UU|��U� � ���U���� ��� OR CONTRACTORS������mmm�*u�x�^m� m^����wum���� ����"=°�"=��� ~�~�.�-_�__--- --- - CONoRACuORS - AUTOMATIC STATUS WHEN ������0N���Q��� ��� �� �����N�~�~N��� ������N�1���N ��m������� u�m�"�V�m�m�m��� mn� �n WRITTEN� =~.� CONSTRUCTION .~~--~ ' -_-- - ����U�������� 0�8~�U� ~���U� � ����m���m~x�,��u� m m�mmm � ° ��`= � ' This endorsement modifies insurance provided under the following: � � � COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section lU ' Whw 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 vvbomn 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 Po|icY' the rendering of, or the failure to render, any Such person or organization is an additional professional arnhitactura|, engineering or insured only with respect to liability for "bodily surveying services, including: injury", "property damage" or "personal and m_ The preparing, approving, or failing to mdve�isinginju�" cauoed. inwhm|eorinpa� prepare or e. maps, shop drawings, 1~ Your acts or omissions; or opiniona, reportm, ourveys, field orders, 2- The eotm or omissions of those acting on your change orders or drawings and � behalf; specifications; or in the performance of your ongoing operations for b. Supemieory, inapeotion, architectural or the additional insured. engineering activities. However' the insurance afforded to such This exclusion applies even if the o|aina additional insured: against any i at insured allege negligence urother 1^ Only applies to the extent permitted by law; wrongdoing in the auporvioion, hiring. and employment, training or monitoring of others which c 2_ Will not be broader than that which you are by caused that inauned, if the "occurrence"the "bodily injury" or "ProPe�Y required by the contract or agreement to damage",� ur the offense which caused the provide for such additional, i»e«ned' �persona| and advertising i ury". in«o»ndthe A pmrson'o or orgun1zmtion's 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. (D Insurance Services Office, Inc., 2018 Page of CG 2033 12 19 Policy Number: 9837473 Transaction Effective Date: 10/08/2028 2. "Bodily injury" or "property damage" C. With respect to the insurance afforded to these occurring after: additional inaureds, the kd|ovvnO is added to w' All work, including nnut*ha|o, puda or Section III - Limits 0f Inaumemoe. equipment furnished in connection with The most we will pay on behalf of the additional such vvurk, on the project (other than insured ie the amount cfinauranoe' aemioen�antenonmeor repairs) to be 1' Required by the contract or agreementyou performed oyoron behalf o|1ke additional " ----- insured(s) at the location of the covered or entered into with the additional insured; mr operations has been completed; ur ----- �~ That portion of "your work" out of which �~ Available under the applicable limits c� the injury ordummagoohaem has been put insurance; � to its intended use by any person or »vhichev�ris |oem. 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 ofthe same project. � � � � Page 2of2 (D Insurance Services Office, |nc. 2O18 CG 20 33 12 19 Policy Number: U837473 Transaction Effective Date: 1O/O8/2028