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Home My WebLink AboutInsurance Certificate: Johnny Cat :rry RECORDER ACORD". CERTIFICA TE OF LIABILITY INSURANCE I DATE (MMlDD/YYYY) 3/6/2008 PRODUCER (541) 772-1111 FAX: (541) 772-3785 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION JBL&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 'II INSURED INSURER A North Pacific Insurance 23892 Johnny Cat Inc INSURER B Indemni ty Company of CA POBox 89 INSURER c: INSURER D. Jacksonville OR 97530 INSURER E THE POLICIES OF INSURANCE L1STI:D 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. -- INSR ADD'L Pg}+~1~~~6g,;!~ Pg~!fJ/~,X;~t;~~N LIMITS 'T" ,,,,,,,,n Type or INSURANCE POLICY NUMBER GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 - ~~~~:~H9E~~JLT.Pencel X COMMERCLAL GENERAL L1A,BILlTY $ 100,000 - ~. CLAIMS MADE [!] OCCUR 3/5/2009 A X C03165696 3/5/2008 MED EXP (An one oerson" $ 5,000 - PERSONAL & ADV INJURY $ 1,000,000 - GENERAL AGGREGATE $ 2,000,000 - GEN'L AGGREGATE LIMIT APlS PER PRODUCTS. COMP/OP AGG $ 2,000,000 Xl n PRO- POLLUTION LIABILITY $ 1,000,000 POLICY JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 r-- (Ea accident) $ X ANY AUTO r-- 3/5/2008 3/5/2009 A ALL OVVN~U AU I ()~ C031Ci!\Ci9Ci BODILY INJURY I-- (Per person) $ SCHEDULED AUTOS - - HIRED AUTOS BODILY INJURY $ f-JON-OVvNED AUTOS (Per accident) - - PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ R ANY AUTO OTHER THAN EA ACC $ AUTO ONL Y AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 2,000,000 m OCCUR D CLAIMS MADE AGGREGATE $ $ A R DEDUCTIBLE C03165696 3/5/2008 3/5/2009 $ RETENTION $ $ WORKERS COMPENSATION AND I T~JltJI~s I laTH- ER EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? EL DISEASE - EA, EMPLOYEE $ If yes, describe under SPFCIAL PROVISIONS below EL DISEASE. POLICY LIMIT $ B OTHER PREVAILING WAGE BOND 741085C 3/22/2008 3/22/2009 BOLl BOND $ 30,000 DESCRIPTION OF OPERATIONs/LOCATIONs/VEHICLEs/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Re: 1-5 Sanitary Sewer Construction Project No. 2007-15, Certificate holder included as additional insured per attached endorsement LGL40320705 where required by contract. Subject to policy terms, conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Ashland and ODOT, its officers, EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL employees and agents 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT James Olsen - Engineering - FAILURE TO DO so SHALL IMPOSE NO 08LIGA TION OR LIABILITY OF ANY KIND UPON THE 20 East Main street Ashland, OR 97520 ~. INSURER. ITS AGENTS OR REPRESENTATIVES. '>C/C C6r(J6 AUTHORIZED REPRESENTATIVE ~'7~ \ - - K Edwards/KIMED ACORD 25 (2001/08) INS025 (0108) 08a @ ACORD CORPORATION 1988 Pagelof2 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) 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 (2001108) INS025 i010B}.08a Page 2of2 BLANKET ADDITIONAL INSUREDS - CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. A. Section 11- Who Is An Insured is amended to include as an insured the following: 1. Any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability caused in whole or in part by: a. Your acts or omissions; or b. The acts or omissions of those acting on your behalf; In the performance of your ongoing operations performed for that additional insured. A person's or organization's status as an insured under this endorsement ends when your operations for that additional insured are completed. 2. Any person or organization from whom you lease a premises when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an insured only with respect to liability caused in whole or in part by your ownership, maintenance, or use of that part of the premises leased to you by such person or organization. A person's or organization's status as an insured under this endorsement ends when their contract or agreement with you for such leased premises ends. 3. The architects, engineers or surveyors, while not engaged by you, that are contractually required to be added as an additional insured to your policy, but only with respect to liability caused in whole or in part by: a. Your acts or omissions; or b. The acts or omissions of those acting on your behalf; In the performance of your ongoing operations performed by you or on your behalf. B. With respect to the insurance afforded these additional insureds, the following additional exclusions apply: 1. The insurance afforded under Paragraph 1.A.1. and 1.A.3. of this endorsement does not apply to: "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: A. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders. drawings, deSigns or specifications; and B. Supervisory, inspection, architectural or engineering activities. 2. The insurance afforded under Paragraph 1.A.2. of this endorsement does not apply: A. To any "occurrence" which takes place after you cease to be a tenant in that premises; B. To structural alterations, new construction or demolition operations performed by or on behalf of the person or organization from whom you lease the premises. LGL 40 32 07 05 Contains ISO copyrighted material, with its permission Copyright, Insurance Services Office, Inc., 2004 C 841 00