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Home My WebLink AboutPacific Paving CITY RECORDER'S COpy ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE(MMlDDNYVY) 3/21/06 PRODUCER (541) 772-1111 FAX (541) 772-3785 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Security Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 707 Murphy Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Medford OR 97504 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: st Paul Travelers Pacific Paving Inc INSURER B: PO Box 2370 INSURER C. INSURER D: White City OR 97503 INSURER E COVERAGES 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 CERTlFICATE 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE (MM/DDNY) DATE (MMlDDIYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 I-- 8~~~~?E~~J~P..nce) 100,000 X OMMERCIAL GENERAL LIABILITY $ t-- CLAIMS MADE [!] OCCUR 3/20/2006 3/20/2007 A DTC0526D8417TILD6 MED EXP (Anyone person) $ 5,000 t-- PERSONAL & ADV INJURY $ 1,000,000 t-- 2,000,000 GENERAL AGGREGATE $ t-- 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ !Xl POLICY n ~~8T n LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 I-- (Ea accident) $ X ANY AUTO I-- 3/20/2006 3/20/2007 A ALL OI/ltNED AUTOS DT810526D8417TIL06 BODILY INJURY I-- (Per person) $ SCHEDULED AUTOS t-- I-- HIRFO AIITOS BODILY INJURY $ NON-OI/ItNED AUTOS (Per accklent) I-- I-- PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO DNL Y - EA ACCIDENT $ R ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG $ EXCI:S5IUMBRELLA LIABILITY EACH OCCURRENCE $ 1,000,000 o OCCUR D CLAIMS MADE AGGREGATE $ $ A @ DEDUCTIBLE DTSMCUP526D8417TIL06 3/20/2006 3/20/2007 $ X RETENTION $10,000 $ WORKERS COMPENSATION AND I T"d'R~m:WS I IOJ~- EMPLOYERS' LIABILITY ANY PROPRIETORlPARTNERlEXECUTlVE EL. EACH ACCIDENT $ OFFICERlMEMBER EXCLUDED? E.L DISEASE - EA EMPLOYEE $ If yes, describe under EL. DISEASE - POLICY LIMIT $ SPECIAL PROVISIONS belOlN OTHER DESCRIPTION OF OPERA TION5ILOCA TIONSlVEHICLE5IEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Certificate holder included as additional insured per attached endorsement #CGD2460805 where required by contract. Subject to policy terms, conditions and exclusions. CERTIFICATE HOLDER CANCELLA nON SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Ashland EXPIRATION DATE THEREDF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 90 North Mountain Avenue 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT Ashl.and, OR 97520 - FAILURE TO DO so SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE :::;.,-<- ~. u./~ Susan Wilson, AAI, ACORD 26 (2001/08) INS026 (0108).06 AMS VMP Mortgage Solutions, Inc. (800)327-0545 @ ACORD CORPORA nON 1988 Page1of2 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED - (Section II) is amended to include any person or organization that you agree in a "written contract requiring insurance" to include as an additional insured on this Cover- age Part, but: a) Only with respect to liability for "bodily injury", "property damage" or "personal injury"; and b) If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies. The person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. 2. The insurance provided to the additional insured by this endorsement is limited as follows: a) In the event that the Limits of Insurance of this Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance", the in- surance provided to the additional insured shall be limited to the limits of liability re- quired by that "written contract requiring in- surance". This endorsement shall not in- crease the limits of insurance described in Section 111- Limits Of Insurance. b) The insurance provided to the additional in- sured does not apply to "bodily injury", "prop- erty damage" or "personal injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or sur- veying services, including: i. The preparing, approving, or failing to prepare or approve, maps, shop draw- ings, opinions, reports, surveys, field or- ders or change orders, or the preparing, approving, or failing to prepare or ap- prove, drawings and specifications; and ii. Supervisory, inspection, architectural or engineering activities. c) The insurance provided to the additional in- sured does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products-completed op- erations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such "bodily injury" or "property damage" that oc- curs before the end of the period of time for which the "written contract requiring insur- ance" requires you to provide such coverage or the end of the policy period, whichever is earlier. 3. The insurance provided to the additional insured by this endorsement is excess over any valid and collectible "other insurance", whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover under this endorsement. However, if the "written contract requiring insurance" specifically requires that this insurance apply on a primary basis or a primary and non-contributory basis, this insurance is primary to "other insurance" available to the additional insured which covers that person or organization as a named insured for such loss, and we will not share with that "other insurance". But the insurance provided to the additional insured by this endorsement still is excess over any valid and collectible "other in- surance", whether primary, excess, contingent or on any other basis, that is available to the addi- tional insured when that person or organization is an additional insured under such "other insur- ance". 4. As a condition of coverage provided to the additional insured by this endorsement: a) The additional insured must give us written notice as soon as practicable of an "occur- rence" or an offense which may result in a claim. To the extent possible, such notice should include: CG 02 46 08 05 @ 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 r- r COMMERCIAL GENERAL LIABILITY i. How, when and where the "occurrence" or offense took place; ii. The names and addresses of any injured persons and witnesses; and iii. The nature and location of any injury or damage arising out of the "occurrence" or offense. b) If a claim is made or "suit" is brought against the additional insured, the additional insured must: i. Immediately record the specifics of the claim or "suit" and the date received; and II. Notify us as soon as practicable. The additional insured must see to it that we receive written notice of the claim or "suit" as soon as practicable. c) The additional insured must immediately send us copies of all legal papers received in connection with the claim or "suit", cooperate with us in the investigation or settlement of the claim or defense against the "suit", and otherwise comply with all policy conditions. d) The additional insured must tender the de- fense and indemnity of any claim or "suit" to any provider of "other insurance" which would cover the additional insured for a loss we cover under this endorsement. However, this condition does not affect whether the insur- ance provided to the additional insured by this endorsement is primary to "other insur- ance" available to the additional insured which covers that person or organization as a named insured as described in paragraph 3. above. 5. The following definition is added to SECTION V. - DEFINITIONS: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional in- sured on this Coverage Part, provided that the "bodily injury" and "property damage" oc- curs and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Page 2 of 2 @2005 The St. Paul Travelers Companies, Inc. CG 02 46 08 05 r.----r- ACORDN CERTIFICATE OF LIABILITY INSURANCE OP 10 J~ DATE (MMIDDIYYYY) PAC:I05W 09/27/06 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE KPD :Insurance, :Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR PO Box 784 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Springfie~d OR 97477 Phone: 541-741-0550 Fax:541-741-1674 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: SA:IF Corporation - Sa~em INSURER B: Pacific Paving, :Inc. INSURER C: PO Box 2370 INSURER 0: White City OR 97503 INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSRi TYPE OF INSURANCE POLICY NUMBER ~<i~i:m~~~ P8k,&Y,~':,b~J!RN LIMITS ~NERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY ~~EMISES (Ea occurence) $ - h CLAIMS MADE D OCCUR MED EXP (Anyone person) $ -. - PERSONAL & ADV INJURY $ - GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COM~OPAGG $ I nPRO- n POLICY JECT LOC ~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) - - ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) - - HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) - - PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ~ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ :5ESSJUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR D CLAIMS MADE AGGREGATE $ $ R DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND : 1_ W~~.TA!_U- I IOTH- X TORY LIMITS ER A EMPLOYERS' LIABILITY 812919 10/01/06 10/01/07 E.L. EACH ACCIDENT $ 500 . 000 ANY PROPRIETORlPARTNERlEXECUTIVE OFFtCERlMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $500.000 ~~~I~~~~~v':~?6~s below E.L. DISEASE - POLICY LIMIT $500.000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS RE: M~ Operations CERTIFICATE HOLDER Ci ty of Ash~and Attn: Kari O~son 90 N MOuntain Ave. Ash~and OR 97520 CANCELLATION C:ITAS02 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATlO DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO so SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHO REPRE~ENTA~ @ ACORD CORPORATION 1988 ACORD 25 (2001/08)