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Home My WebLink AboutSouthern Oregon Automatic Door c!fV RECORDER AQORD", CERTIFICA TE OF LIABILITY INSURANCE DATE IMMlDD/YVYYj 11/27/2007 PRODUCER (541)536-1726 FAX: (541)536-1568 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Little River Investments ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Bancorp Insurance , ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 327, 51477 Hwy 97 La Pine OR 97739 .. INSURERS AFFORDING COVERAGE NAIC# -- INSURED INSURER A. Am Hallmark Ins Co of TX Robert Jerome Keller, DBA: Southern Oregon INSURER B: 200 Rogue Rim Dr INSURER C INSURER D: Merlin OR 97532 INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITlON 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. ..un,,: ~,-~ ,'.-- ....... ~ ....y PAin CLAIi..1S .-- .-. .- I~;: ~~~~ TYPE OF INSURANCE POLICY NUMBER p~.km~~~6g~'1 '"<6klfJI~":;~~!gN LIMITS ~NERAL lIABILITY EACH OCCURRENCE $ 1,000,000 ..!.. 3MMERCIAL GENERAL LIABILITY ~~~~~~?E~~J~~nre\ $ 100,000 A X - CLAIMS MADE [!] OCCUR 44CL446596 10/10/2007 10/10/2008 MED EXP (Anv one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 - GENERAL AGGREGATE $ 2,00_~ -il'L AGGREr~E LIMIT An" PER PRODUCTS - COMP/OP AGG $ 2,0~~ X POLICY ~~C?T LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 - (Ea accident) $ -- ANY AUTO ------.-- -.---- A X - ALL OWNED AUTOS BODILY INJURY 10/10/2008 (Per person) $ ~ SCHEDULED AUTOS 44CL446596 10/10/2007 ~ HIRED AUTOS BODILY INJURY $ X NON.OWNED AUTOS (Per accident) - ---.- -- --- PROPERTY DAMAGE $ (Per accident) GARAG E LIABILITY t==n AUTO ONLY. EA ACCIDENT ~----- R ANY AUTO : g "-",. OTHER THAN EA ACC S .--- ' i I't~:j(:r:~- ~!cat'9 of jn~1 ALlTO ONLY --~_. .. ~ AGG $ ~ . ~"."... ~ ~t~~:~:~-::;-_"; ~:' ;~-'C;;:Jy EXCESSlUMBRELLA LIABILITY in C:.~, EACH OCCURRENCE $ tJ OCCUR 0 Cl.AIMS MADE be in c~ . . ....:;;/ (,1 ...;;~ v not AGGREGATE ---- $ I j any w,:"",: ..~..~"J L~'fth I .-,----I-~- C~i;ii'"iict. " I ----.- --,,-'. -..,. -._----. H.__"_'___',,__,"_, R DEDUCTIBLE $ -- RETENTION $ WORKERS COMPENSATION AND I '<\C ST ATU- ; I OTH- TORY LIMITS Eft... --------- EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE El.. EACH ACCIDENT -- .i__.______ OFFICERIMEMBER EXCLUDED? E.L. DISlOASE EA EMPLOYEE $ If yes, describe under __0_-- "PI,CIAL PROVISIONS below E.L. DISEASE. POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONSlLOCATIONSlVEHICLESlEXCLUSIONSADDED BY ENDORSEMENT/SPECIAL PROVISIONS Certificate holder is l~sted as an additional insured per attached MP 97 67 06 05 rf2-rJ tJl7174J CERTIFICATE HOLDER CANCELLATION (541)488-5320 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Ci ty of Ashland EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Purchasing Representative 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT Attn: Kari Olson - FAILURE TO DO so SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE 90 N Mountain Avenue Ashland, OR 97520 INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ~ ~c ". Pam Dressler/BETH lIS- . ----- ACORD 25 (2001/08) INS025 (0108).08. @ACORD CORPORATION 1988 Page 1 of 2 IMPORT ANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). D!SCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/08) INS025 (0108\08a Poge 2 of 2 NAME (First Named & Other Named Insureds) Southern Oregon Automatic Door Southern Oregon Automatic Door OFAPPINF ADDITIONAL NAMED INSUREDS Doing Business As Doing Business As COPYRIGHT 2000, AMS SERVICES INC The deductible of $500 does not apply to rental reimbursement expenses. General liability Additional Coverages The following Additional Coverages are added to the COMMERCIAL GENERAL lIAB1L1TY COVERAGE FORM. A. Blanket Additional Insured Coverage 1. SECTION 11- Who Is An Insured ofthe COMMERCIAL GENERAL UABlUTY COVERAGE FORM is amended to incfud as an insured any person or organization (referred to as Additional Insured) whom you are required to add as a Additional Insured on this policy under: a. A written contract or agreement; and b. Where a certificate of insurance showing that person or organization as an additional insured has been issued; an c. When the written contract or agreement and certificate of insurance are currently in effect or becoming in effe( during the term of the policy and executed prior to the "bodily injury," "property damage," or "personal and advertisin injury. " 2. The insurance prOvided to the Additionallnsured(s) is limited as follows: a. The Additionallnsured(s) is only an additional insured for: (1) "Bodily injury," "property damage;' or "personal and advertising injury" caused in whole or in part by negliger acts or omissions of the Named Insured or anyone directly or indirectly employed by the Named Insured or fc whose acts a Named Insured may be liable. (2) Liability arising out of your ongoing operations for the Additional Insured(s) by or for you. A person's ( organization's status as an insured under this coverage ends when your operations for that insured ar completed. b. The limits of Insurance applicable to the Additionallnsured(s) are those specified in the written contract or agreemel but nor more than the Limits of Insurance specified in the Declarations for this policy. The Limits of Insuranc applicable to the Additionallnsured(s) are inclusive of and not in addition to the Limits of Insurance shown in th Declarations for the Named Insured. 3. In addition to the other exclusions applicable to Section I, Coverages A.. B. and C. of the COMMERCIAL GENERA UABllITY COVERAGE FORM, the insurance provided to the Additionallnsured(s) does not apply to: a. "Property damage" to: (1) Property owned, used, occupied. by. loaned or rented to the Additionallnsured(s); (2) Property in the care, custody or control of the Additionallnsured(s) or over which the Additionallnsured(s) are f( any purpose exercising physical control; or (3) "Your work" performed jor the Additionallnsured(s). b. "Bodily injury," "property damage," or "personal and advertising injury" arising out of an architect's, engineer's ( surveyor's rendering or failure to render any professional services for you, for the Additionallnsured(s) or for other! including, but not limited to: (1) The preparing, approving or failure to prepare or approve maps, draWings, opinions, reports, surveys, chang orders, designs or specifications; or (2) Supervisory, inspection or engineering services. c. "Bodily injury" or ~property damage" occurring after: (1) All work, inclUding materials, parts or equipment furnished in connection with such work, on the project (othl than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) atthe site oftt covered operations has been completed; or (2) That portion of "your workD out of which the injury or damage arises has been put to its intended use by ar person or organization other than another contractor or subcontractor engaged in performing operations for principal as a part of the same project. B. Mobile Equipment Broadened Coverage V.12.f.(1) of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM is replaced by the folloWing: (1) Equipment designed primarily for: Page 12 of 15 Includes copyrighted material of ISO Properties, Inc. and MP 97 67 06 05 American Association of Insurance Services, Inc., used with their permission A_CORDTN CERTIFICA TE OF LIABILITY INSURANCE DATE (MMlDDIYYYY) 11/27/2007 PRODUCER (541) 536-1726 FAX: (541)536-1568 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Little River. Investments ONLY AND CONFERS NO' . RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE. DOES'NOT--AMEND; -exTEND' OR Bancol:p InsuJ:lance ALTER THE COVERAGE AFFORDED. BY THE POLICIES BELOW. P.O. BoX: 32~,..51477 Hwy 97 >--_.+ .- - "-- .. - --,,-- '-+" ..-. h .- , - ~,Pine J'iH .. . <.;..' '; OR 97739 INSURERS AFFORDING COVERAGE NAIC# INSURED - .,..' INSURER A: Am Hallmark Ins Co of TX ., Robert Jerome Ke11er, DBA: Southern Oregon INSURER B: 200 Rogue Rim Dr INSURER C' INSURER D: Merlin OR 97532 INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CON DillON 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 CONDIllONS OF SUCH POLICIES, I . p.o.ln ~I .o.IM~ I~;;! A~~~I I I POLICY EFFECTIVE POLICY EXPIRATION I LIMITS lie;:: " TYPE OF INSURANCE POLICY NUMBER DATE IMM/DDIYYI DATE lMMlDDIYYl ~NERAL LIABILITY EACH OCCURRENCE $ 1,000,000 ~ OMMERCIAL GENERAL LIABILITY S~~~~~9E~~~~~nce $ 100,000 A X I-- CLAIMS MADE ~ OCCUR 44CL446596 10/10/2007 10/10/2008 MED EXP 'Anv one Derson) $ 5,000 I-- PERSONAL & ADV INJURY $ 1,000,000 ~ GENERAL AGGREGATE $ 2,000,000 @'LAGGREnELlMIT nES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY ~~8T LOC ~TOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ~ ANY AUTO I-- . ALL OVvNE[) AUTOS BODILY INJURY - (Perperson) $ :1-- SC[lEDULED AUTOS HIRED AUTOS r'++ --==....) .... 1- BODILY INJURY (Per accident) $ NON-OVvNED AUTOS # Ii ....0:-,..., -~ I-- ! i '..:::; C"",-u'i ~', . :~'~"',:.~~<~~ ~.;,.~~~~ iQ Of' I-- 4.. 1"~!.!"8nce PROPERTY DAMAGE $ I.. I;' In (:.O' . "- C.. . 2ft:: -.) ''',~~_.~ (Per accident) RAGE LIABILITY V l be in " -:.' ~/. ,,1 iiiay no ", AUTO ONLY - EA ACCIDENT $ --~- an ->'., '......~'.::;-. ..) L~ith I. ANY AUTO _ Y wr'''"n C(;j OTHER THAN EA ACC "roct. .. AUTO ONLY' AGG $ , EXCESS/UMBRELLA LIABILITY EACH acCI JRRFNCE $ o OCCUR D CLAIMS MADE AGGREGATE $ $ R DELJUClll3LE I I ~.._-_._------- i-L----- ....-...--.--. - RETENTION $ I. WORKERS COMPENSATION AND I \o\C STATU, ; I IOTH- 1-_ fORY LIMITS ER EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? EL. DISEASE - EA EMPLOYEE $ If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONs/LOCATIONSlVEHICLEs/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Certificate holder is listed as an additional insured per attached MP 97 67 06 05 CERTIFICATE HOLDER CANCELLATION (541)488-5320 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Ashland EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Purchasing Representative 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT Attn: Kari Olson - FAILURE TO DO so SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE 90 N Mountain Avenue Ashland, OR 97520 INSURER, ITS AG ENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ~ ~.~I Pam Dressler/BETH .. . ACORD 26 (2001/08) INS025 (010S).oeo @!\COR.D CORPORATION 1988 ClTV RECORDER Page 1 of 2 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/08) INS025 (0108).08a Page 2 of 2 NAME (First Named & Other Named Insureds) Southern Oregon Automatic Door Southern Oregon Automatic Door OFAPPINF ADDITIONAL NAMED INSUREDS Doing Business As Doing Business As COPYRIGHT 2000, AMS SERVICES INC The deductible of $500 does not apply to rental reimbursement expenses. General Uability Additional Coverages The following Additional Coverages are added to the COMMERCIAL GENERAL LIABILITY COVERAGE FORM. A. Blanket Additional Insured Coverage 1. SECTION 11- Who Is An Insured of the COMMERCIAL GENERAL UABILlTY COVERAGE FORM is amended to inctud as an insured any person or organization (referred to as Additional Insured) whom you are required to add as a Additional Insured on this policy under: a. A written contract or agreement; and b. Where a certificate of insurance showing that person or organization as an additional insured has been issued; an c. When the written contract or agreement and certificate of insurance are currently in effect or becoming in effe< during the term of the policy and executed prior to the "bodily injury," "property damage," or "personal and advertisin injury." 2. The insurance provided to the AddItionallnsured(s) is limited as follows: a. The Additionallnsured(s) is only an additional insured for: (1) "Bodily injury," "property damage," or "personal and advertising injury" caused in whole or in part by negliger acts or omissions of the Named Insured or anyone directly or indirectly employed by the Named Insured or fc whose acts a Named Insured may be liable. (2) Liability arising out of your ongoing operations for the Additional Insured(s) by or for you. A person's ( organization's status as an insured under this coverage ends when your operations for that insured ar completed. b. The limits of Insurance applicable to the Additional Insu red (5) are those specified in the written contract or agreemel but nor more than the Limits of Insurance specified in the Declarations for this policy. The Limits of Insuranc applicable to the Additionallnsured(s) are inclusive of and not in addition to the Limits of Insurance shown in th Declarations for the Named Insured. 3. In addition to the other exclusions applicable to Section I, Coverages A., B. and C. of the COMMERCIAL GENERA LIABILITY COVERAGE FORM, the insurance provided to the Additionallnsured(s) does not apply to: a. "Property damage" to: (1) Property owned, used, occupied by, loaned or rented to the Additionallnsured(s); . (2) Property in the care, custody or control of the Addltionallnsured(s) or over which the Addltlonallnsured(s) are f( any purpose exercising physical control; or (3) "Your work" performed for the Additionallnsured(s). b. "Bodily injury," "property damage," or "personal and advertising injury" arising out of an architect's, engineer's ( surveyor's rendering or failure to render any professional services for you, for the Additionallnsured(s) or for other~ including, but not limited to: (1) The preparing, approving or failure to prepare or approve maps, drawings, opinions, reports, surveys, chang orders, designs or specifications; or (2) Supervisory, inspection or engineering services. c. "Bodily injury" or "property damage" occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (Othl than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of tt covered operations has been completed; or (2) That portion of "your workD out of which the injury or damage arises has been put to its intended use by ar person or organization other than another contractor or subcontractor engaged in performing operations for principal as a part of the same project. .1 I I I \ B. Mobile Equipment Broadened Coverage V.12.f.(1) of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM ;s replaced by the following: (1) Equipment designed primarily for: Page 12 of 15 Includes copyrighted material of ISO Properties, Inc. and MP 97 67 06 05 American Association of Insurance Services, Inc., I,Ised with their permission