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Home My WebLink AboutInsurance Certificate: Key Line Construction ACORDm PRODUCER (541) 772-1111 FAX: (541) 772-3785 Beecher carlson Insurance Agency LLC 707 Muzphy Rd CERTIFICATE OF LIABILITY INSURANCE I ~1ii2/2008) THIS CERTlFICATE IS ISSUED AS A MATTER OF INFORMAll0N ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERllFICATE DOES NOT AMEND, EXTEND OR AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ~orc1 INSURED Key Line Construction, Inc. 6697 To1o Road OR 97504 INSUReRS AFFORDING COVeRAGe NAIC # INSURER A Financial Pacific Ins CO INSURER B 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 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 POLICY EFFECTIVE POLICY EXPIRATION I TR II\l""Rn TVrE: or INOUAANCE: rOllCY NUMDE:A DAT~ CMMlDDlYYl OAT!! CMMIDDlYYl liMITS A GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 - 8~~~~J9E~~~J~~ence 1 X COMMERCIAL GENERAL LIABILITY $ 100,000 I CLAIMS MADE ~ 0(:(:1 JR 173496D 11/22/2008 11/22/2009 MED EXP (Anv one Derson\ $ 5,000 PERSONAL & mv INJURY $ 1,000,000 f-- I-- GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRonll(:TS - (:OMP/OP Ac;(; $ 2,000,000 Xl nPRO- n X POLICY i:CT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 - (Ea accident) $ _ ANY AUTO ALL o VV1\I cU AU I O~ 1734960 11/22/2008 11/22/2009 BODIL Y INJURY - (Per person) $ ~ SCHEDULED AUTOS ~ HIRED AUTOS BODILY INJURY $ ~ NOf\I-OW\JED ,II,UTOS (Per aCCl dent) - PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EAACCIDENT $ R ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 5,000,000 ~ OCCUR D CLAIMS MADE AGGREGATE $ 5,000,000 $ ~ DEDUCTIBLE 922533D 11/22/2008 11/22/2009 $ X I<ETENT Im~ It 0 It WORKERS COMPENSATION AND IT~~T~JHs I IO~~- EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? EL DISEASE- EA EMPLOYEE $ If yes, aeSCrlDe unaer SPECIAL PROVISIONS below EL DISEASE - POLICY LIMIT $ OTHER Leased or Rented 1734960 11/22/2008 11/22/2009 Limit $100,000 Equipment ---------- Deductible $1,000 A A A DESCRIP~ON OF OPERATlONSA.OCATIONS LES":XCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Re: Quincy Street Pri Fault Repair Project 1000085 The City of Ashlan , its officers, and employees shall be named as Additional Insured as respects to General ~~~~~~~ 10 Y Rotice ot cance11atr:;;~;n;;~o~. ::Z-:;7;'m1~diUon~a:R__ CERllFICATE HOLDER /I v CANCELLATlON \J SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Ashland 90 N Mountain Avenue Aah1and, OR 97520 EXPIRATION DATE THEREOF, THE ISSUING INSURER ....,LL ENDEAVOR TO MAIL ~ DAYS Y't'RmEN 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 -.J:h,....~ --4 Darrin Godfrey/KRISMA ~ @ACORDCORPORATlON 1988 Page1of2 ACORD 25 (2001/08) INS025 (0108).08a POLICY NUMBER: 1734960 COMMERCIAL GENERAL LIABILITY CG 20 10 Blanket Additional Insured 01 08R THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED · OWNERS, LESSEES OR CONTRACTORS (WITH LIMITED COMPLETED OPERATIONS COVERAGE) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART BUSINESSOWNERS COVERAGE FORM NAME OF PERSON OR ORGANIZATION: Any person or organization to whom or to which the named insured is obligated by a virtue of a written contract to provide insurance that is afforded by this policy. Where required by contract the officers, officials, employees, directors, subsidiaries, partners, successors, parents, divisions, architects, surveyors and engineers are included as additional insureds. All other entities, including but not limited to agents, volunteers, servants, members and partnerships are included as additional insureds, if required by contract, only when acting within the course and scope of their duties controlled and supervised by the primary (first) additional insured. If an Owner Controlled Insurance Program is involved, the coverage applies to off-site operations only. If the purpose of this endorsement is for bid purposes only, then no coverage applies. WHO IS AN INSURED:(Section II) This section is amended to include as an insured the person or organization shown on the Certificate of Insurance, but only to the extent that the person or organization is held liable for your acts or omissions arising out of and in the course of "your work" for that person or organization by or for you. The "products-completed operations hazard" portion of the policy coverage does not apply to any work involving or related to properties intended for residential or habitational occupancy (other than apartments) . WAIVER OF SUBROGATION: We waive any right of recovery, when required by written contract, that we may have against the person or organization shown in the Certificate of Insurance because of payments we make for injury. LOCA liON OF JOB: The job location must be within the State of domicile of the named insured, or within any contiguous State thereto. SCHEDULE DESCRIPTION OF WORK: The type of work performed must be that as described under classifications in the CGL Coverage Part Declarations. CONDUIT CONSTR FOR CABLESIWIRES PRIMARY CLAUSE: When this endorsement applies and when required by written contract, such insurance as is afforded by the general liability policy is primary insurance and other insurance shall be excess and shall not contribute to the insurance afforded by this endorsement. EXCLUSION: The insurance provided to the additional insured does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of an architect's, engineer's or surveyor's rendering or failure to render any professional services, including: 1. "The preparing, approving, or failing to prepare or approve, maps, designs, shop drawings, opinions, reports, surveys, field orders, change orders, or drawings and specifications; and 2. Supervisory, inspection, architectural or engineering activities. Endorsement EFFECTIVE DATE: Endorsement Nov/22/2008 EXPIRATION DATE: Nov/22/2009 CG 20 10 Blanket Additional Insured 01 08R Includes copyrighted material of Insurance Services Office, Inc., with Its permission Page 1 of 1 --r---