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Home My WebLink AboutKey Line Construction L. ACORD". CERTIFICATE OF LIABILITY INSURANCE )DUCER (541) 772-1111 FAX: (541) 772-3785 JBL&K Insurance Agency 707 Murphy Rd DATE (MMlDD/YYYY) 11/21/2007 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Medford INSURED Key Line Construction, Inc. 6687 Tolo Road OR 97504 INSURERS AFFORDING COVERAGE INSURER A Financial Pacific INSURER B NAIC# INSURER C: Central Point OR 97502 INSURER D: INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDI110N 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 CONDI110NS OF SUCH POLICIES. I . PAIr' 1" ",..., I~~! I~~~~ TYPE OF INSURANCE POLICY NUMBER P~,.t+~~~~~g&RVE ~~'fl/~rX'o~'$:N LIM'TS GENERAL LIABILITY EACH OCCURRENCE $ r- ~~~~~JJ~~r~Pence\ ~t5MMERCIAL GENERAL LIABILITY $ A X _ CLAIMS MADE ~ OCCUR l73496C 11/22/2007 11/22/2008 MED EXP (Anyone De/Son) $ PERSONAL 8. flDV INJURY $ - GENERAL AGGREGATE $ - GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ Xl POLICY n ~~. n LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT - (Ea accident) $ I-- ANY AlITO A ALL UWNcU AU I U::; 1.73496C 11/22/2007 11/22/2008 BODILY INJURY r- (Per person) $ ~ SCHEDULED AUTOS X HIRED AUTOS BODILY INJURY $ r-- (Per accident) X NON-OWNED ALTTOS r- - PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $ q ANY AlITO OTHER THAN EA ACC $ AlITO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH CE $ ::::J OCCUR o CLAIMS MADE AGGREGATE $ $ A ~ DEDUCTIBLE 922533C 11/22/2007 11/22/2008 $ :x: RETENTION ~ 0 $ WORKERS COMPENSATION AND I T~lIfJI~S I IOJ~- EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERlEXECUTIVE E.L EACH ACCIDENT $ OFFICERlMEMBER EXCLUDED? E.L DISEASE - Ell, EMPLOYEE $ 11 yes, describe under <:""'r'.' PR()V'<:j()N':; ....lnw EL DISEASE - POLICY LIMIT $ OTHER 1,000,000 100,000 5,000 1,000,000 2,000,000 2,000,000 1,000,000 2,000,000 2,000,000 DESCRIPTION OF OPERA TIONSlLOCA TIONSlVEHICLESJEXCLUSlONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS The City of Ashland, its officers, and employees shall be named as Additional Insured as respects to General Liablli ty . Re: Quincy Street Primary ...----- Repair Project #000085 (ll'~ L_YL, a I 1'hj? ~ ~ ~ ,...~ ?- t:J t'O (C/ CERTIFICATE HOLDER I City of Ashland 90 N Mountain Avenue Ashland, OR 97520 ~ ~ ~ ~ \1 \D ~ \ ~\ ~~N~ ! Bv CANCELLA nON SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 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 REPRESENTATNES. IlAUTHORIZEDREPRESENTATNE ~-4 arrin Godfrey/AMBESL ~ @) ACORD CORPORATION 1988 Page1of2 ACORD 25 (2001/08) INS025 (0108),08a CITY OF ASHLAND Fax DATE: November 28, 2007 TO: JBL&K Insurance Agency FROM: Kari Olson, Purchasing Representative The attached insurance certificate for Key Line Construction regarding the Quincy Street Primary Fault Repair Project #000085 is no longer needed. This project was completed back in 2006. Thank you. Kari Olson Purchasing Representative \.~ ~~. '_.:,~; -.i]) .,c- -;;- - p... ~ .__ tl 7 (SJ Purchasing Finance Department 90 N. Mountain Ashland, Oregon 97520 www.ashland.or.us Tel: 541-488-5354 Fax: 541-488-5320 TTY: 800-735-2900 rA1 --~ ---.-- _._~~._--~~ L ACORD". CERTIFICA TE OF LIABILITY INSURANCE DATE (MMlDD1YYYY) 11/21/2007 )DUCER (541)772-1111 FAX: (541)772-3785 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION J.BL&K Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 707 Murphy Rd ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Medford OR 97504 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Financial Pacific Key Line Construction, Inc. INSURER B: 6687 Tolo Road INSURER c: INSURER D: Central Point OR 97502 INSURER E THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. N01WlTHSTANDING ANY REOUIREMENT, 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 CONDITlONS OF SUCH POLICIES. : BFFN C~I"\IIt"'~1"\ AV PAID CLAIM~ INSR ~~~~ POLICY NUMBER P~,N~1::6g,'h1VE ~~I.fJ,~:~~~N LIMITS ! LTR TYPE OF INSURANCE ~NERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY ~~~~~J9~~NJ~~ncel $ 100,000 A f--- U CLAIMS MADE [!] OCCUR 173496C 11/22/2007 11/22/2008 MED EXP I Anyone oerson' $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 f-- f--- GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COM~OPAGG $ 2,000,000 XI POLICY h- ~~8i r=f LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT - (Ea accident) $ - ANY AUTO - ALL UVllNcU AU I U::; BODILY INJURY $ SCHEDUUED AUTOS (Per person) - ~ - HIRED AUTOS BODILY INJURY $ NON-O\M>JED AUTOS (Per accident) - PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ~ ANY AUTO OTHER THAN EA ACC $ AUTO ONL V: AGG $ EXCESS/UMBRELLA LIABILITY EACH $ =:J OCCUR D CLAIMS MADE AGGREGATE $ $ R DEC1UCTIBLE $ RETENTION $ Is WORKERS COMPENSATION AND I T~ntJNs I IOl~- EMPLOYERS' LIABILITY ANY PROPRIETORlPARTNERlEXECUTIVE EL EACH ACCIDENT $ OFFICERlMEMBER EXCLUDED? EL DISEASE - EA. EMPLOYEE $ II yes, describe under SPECIAL PROVISION'" > A""," EL DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERA TIONSlLOCA TIONSlVEHICLESlEXCLUSlONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS 10 Day Notioe of Canoe11ation for Non-Payment of Premium. Subject to Policy Limits, Terms Conditions and Exolusions. CERTIFICATE HOLDER ~l.E~t::S20 lli ~~ ~ 7 ~~O~f ~ CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL By 30 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. AUTHOR~EDREPRESENTATIVE Darrin Godfrey/AMBESL ~.4. ~ @ ACORD CORPORATION 1988 ACORD 25 (2001/08) INS025 (0108).08. Pagelof2 L ACORD", CERTIFICA TE OF LIABILITY INSURANCE DATE (MMlDDIYYYY) 11/21/2007 'ODUCER (541)772-1111 FAX: (541)772-3785 THIS CERTIFICATE IS ISSUED AS A MAnER OF INFORMATION JBL&K Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERnFICA TE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 707 Murphy Rd ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Medford OR 97504 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A Financial Pacific Key Line Construction, Inc. INSURER B' 6687 Tala Road INSURER c: INSURER D: Central Point OR 97502 INSURER E THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWlTHSTANDING ANY REQUIREMENT, TERM OR CONDI110N 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 CONDI110NS OF SUCH POLICIES. : LIMIT'" I I).I~A'" INSR ADD'L P~,H~~~~~~g,R1 ~~lfJI~:Jl~~N LIMITS TYPE OF INSURANCE POLICY NUMBER GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 - ~~~~~J9E~~~Pence) ~ :3'MERCIAL GENERAL LIABILITY $ 100,000 A CLAIMS MADE ~ OCCUR l73496C 11/22/2007 11/22/2008 MED EXP An one person) $ 5,000 f-- PERSONAL & mv INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 - ~'L AGGREGATE LIMIT AnES PER: PRODUCTS. COMP/OP AGG $ 2,000,000 X n PRO. POLICY JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 f-- (Ea accident) $ f-- ANY AUTO A ALL UV'vNt:U AU I U::; l734915C 11/22/2007 11/22/2009 BODILY INJURY f-- (Per person) $ ..!.. SCHEDULED AUTOS L. ..!.. HIRED AUTOS BODILY INJURY $ ...!.. NON.OV'vNED AUTOS (Per accident) - PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $ ==i' ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY I=A!':I-I NCE $ 2,000,000 ~. OCCUR 0 CLAIMS MADE AGGREGATE $ 2,000,000 $ A ~ DEDUCTIBLE 922533C 11/22/2007 11/22/2008 $ :x: RETENTION $ 0 $ WORKERS COMPENSATION AND I. we STATU.. 1 IOJ~' f6kYiiMIT'" : EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE EL. EACH ACCIDENT $ OFFICERlMEMBER EXCLUDED? EL DISEASE. EA. EMPLOYEE $ 11 yes, describe under ~!':IA' PR()V''''I EL. DISEASE. POLICY LIMIT $ OTHER DESCRIPTION OF OPERA TIONS/LOCATIONSlVEHICLES/EXCLUS/ONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Re: Verification of Insurance 10 Day Notice of Cancellation for Non-Payment of Premium. Subject to Policy Limits, Terms Conditions and Exclusions. CERTIFICATE HOLDER (541)488-5320 City of Ashland 90 N Mountain Avenu Ashland, OR 97520 ~~@~O\TI~~I NOV 2 7 Z007 ~j CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 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, AUTHORIZED REPRESENTATIVE Darrin Godfrey/AMBESL ~4. ~ @ ACORD CORPORA nON 1988 ACORD 26 (2001/08) INS026 (0108)08a Pagelof2