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HomeMy WebLinkAboutInsurance Certificate: Rabe Consulting 78/6/2026 E(MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 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: Malissa Castaneda Great Basin Insurance, Inc. PHONE FAX 2300 Madison Street A/C No Ext: 541-882-5507 A/c,No:541-884-0052 Klamath Falls OR 97603 ADDE-MRESS: malissa.castaneda@hubinternational.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Admiral Insurance Company 24856 INSURED ANDRRAB-02 INSURERB: SAIF Corporation 36196 Andrea Rabe dba: Rabe Consulting INSURERC: 22539 Hwy 140 E INSURER D Dairy OR 97625 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:1241650801 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 INSD WVD POLICYNUMBER MM/DD MM/DD A X COMMERCIAL GENERAL LIABILITY Y FEI-ECC-17227-12 8/22/2025 8/22/2026 EACH OCCURRENCE $2,000,000 DAMAGES( RENTED CLAIMS-MADE OCCUR PREMISES Ea occurrence) ccurrence) $50,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 POLICY❑ PRO ❑ JECT LOC PRODUCTS-COMP/OP AGG $4,000,000 X OTHER: Deductible $2,500 AUTOMOBILE LIABILITY COMBINEDSINGLELIMIT $ 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 UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION 940762 7/1/2026 7/1/2027 X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 A Professional Liability FEI-ECC-17227-12 8/22/2025 8/22/2026 Ea Claim Aggregate 2000000/4000000 Contractors Pollution Liability Ea Claim/Aggregate 2000000/4000000 Deductible 2,500 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) City of Ashland, Oregon and its elected officials,officers and employees are additional insured when required by written contract per the attached form. Coverage is primary&noncontributory. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland Public Works 20 East Main Street AUTHORIZED REPRESENTATIVE Ashland OR 97520 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Andrea Rabe; dba: Rabe Consulting Endorsement Number: 25 Automatic Primary and Non-Contributory Insurance Endorsement Designated Work Or Project(s) This endorsement, effective 08/22/2025, attaches to and forms a part of Policy Number FEI-ECC-17227-12. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the Coverage Part(s) indicated below: CONTRACTORS POLLUTION LIABILITY COMMERCIAL GENERAL LIABILITY SCHEDULE Name of Person or Organization: Any person(s) or organization(s) whom the Named Insured agrees, in a written contract, to provide Primary and/or Non-contributory status of this insurance. However, this status exists only for the project specified in that contract. In consideration of an additional premium of$Applied, and notwithstanding anything contained in this policy to the contrary, it is hereby agreed that this policy shall be considered primary to any similar insurance held by third parties in respect to work performed by you under any written contractual agreement with such third party. It is further agreed that any other insurance which the person(s) or organization(s) named in the schedule may have is excess and non-contributory to this insurance. ECC-548-0317 ©2018, Freberg Environmental, Inc. Page 1 of 1 Andrea Rabe; dba: Rabe Consulting Endorsement Number: 11 ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS BLANKET This endorsement, effective 08/22/2025, attaches to and forms a part of Policy Number FEI-ECC-17227-12. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Or Organization(s) Operations Any person(s) or organization(s) whom the Named Those project locations where this Insured agrees, in a written contract, to name as an endorsement is required by contract. additional insured. However, this status exists only for the project specified in that contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II—Who Is An Insured is amended to B. With respect to the insurance afforded to include as an additional insured the person(s) or these additional insureds, the following is organization(s) shown in the Schedule, but only added to Section III— Limits Of Insurance: with respect to liability for"bodily injury" or If coverage provided to the additional insured "property damage" caused, in whole or in part, is required by a contract or agreement, the by"your work" at the location designated and most we will pay on behalf of the additional described in the Schedule of this endorsement insured is the amount of insurance: performed for that additional insured and included in the "products-completed operations 1. Required by the contract or agreement; or hazard". 2. Available under the applicable limits of However: insurance; 1. The insurance afforded to such additional whichever is less. insured only applies to the extent permitted This endorsement shall not increase the by law; and applicable limits of insurance. 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1