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Home My WebLink AboutInsurance Certificate: Pacific Paving Inc CITY RECORDER A CORDm CERTIFICA TE OF LIABILITY INSURANCE I DATE (MM/DDNYYY) 2/27/2009 PRODUCER (541)772-1111 FAX: (541)772-3785 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Beecher Carlson Insurance Agency LLC 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: Travelers Pacific Paving Inc INSURER B: Developers Surety & Indem INSURER c: PO Box 2370 INSURER D: White City OR 97503 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 L1MIT~ SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I~~: ~~~~ TYPE OF INSURANCE POLICY NUMBER P~k+~~:~~g8,wr Pg~W{~~~~N LIMITS GENERAL LIABILITY EACH OCr.\JRRENCE $ 1,000,000 .....:.- X COMMERCIAL GENERAL LIABILITY ~~~~~J9E~~~J~~n"e\ $ 300,000 A 1 CLAIMS MADE ~ OCCUR DTCOS26D8417TIL09 3/20/2009 3/20/2010 MED EXP tAnv one oerson\ $ 5,000 - PERSONAL & ADV INJURY $ 1,000,000 I-- GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGr, $ 2,000,000 Iil n PRO- n X POLICY :1I=r.T LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 I-- $ X ANY AUTO (Ea accident) I--- A ALL OWNED AUTOS DT810S26D8417TIL09 3/20/2009 3/20/2010 BODILY INJURY I-- $ SCHEDULED AUTOS (Per person) I-- I-- HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accid~nt) I-- - PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ =i A"" AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY ~Ar.1-l $ 1,000,000 ~ OCCUR D CLAIMS MADE AGGREGATE $ 1,000,000 $ A ::;:1 DEDUCTIBLE DTSMCUPS26D8417TIL09 3/20/2009 3/20/2010 $ X RETENTION 9; 10,000 g; WORKERS COMPENSATION AND I TVX~$T~JU~ I IOJ~- EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ B OTHER Contractors 786018C 7/1/2008 7/1/2011 Limit: $20,000 Commercial License Bond DESCRIPTION OF OPERA TIONS/LOCA TIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Certificate holder included as additional insured per attached endorsement #CGD246080S where required by written contract. Subject to policy terms, conditions and exclusions. CERTIFICATE HOLDER (541)488-5320 The City of Ashland, its officers, agents and employees 90 North Mountain Avenue Ashland, OR 97520 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 ACORD 25 (2001108) INS025 (0108).08a FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTH~RIZED REPRESENTATIVE c:::::::- -........ J.i J.// S Wllson, AAl, AlC/SU ~.ig,- ~. PV~ @ ACORD CORPORATION 1988 Page 1 of2 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADD'ITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED - (Section II) is amended c) 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 III - 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 U. Supervisory, inspection, architectural or engineering activities. CG 02 46 08 05 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 insurancel/ specifically requires you to provide suchcovemge 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 I/written contract requiring insurancel/ specifically requires that this insurance apply on a primary basis or a IJrimary and non-conlribulory basis, this insurance is primary to "other insurancel/ 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. A.q :::!I r.nnrlition of r.nvAr:::llgA J1rovirlArI to thA additional insured by this endorsement: a) The additional insured must give us written notir.A :::!IR Roon :::!IR J1r:::!l~tir.RhIA of :::!In "or.r.llr- rence" or an offense which may result in a claim. To the extent possible, such notice should include: @ 2005 The Sl. Paul Travelers Companies, Inc. Page 1 of 2 ~ --- ,- -- -------- - ---,- --nr T COMMERCIAL GENERAL LIABILITY I. How, when and where the "occurrence" or offense took place; U. The names and addresses of any injured persons and witnesscs;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 clajm 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 ::;oon as praclicable. c) The additional insured must immediately send us copies of all legal papers received in connection with the claiill or "suit", cooperate with us in the investigation or settlement of the claim or defense against the "suit", and othelWise 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 ~nd 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 or 2 @ 2005 The Sl. Paul Traveler::; Companies, Inc. CG 02 46 08 05 --~~'--nr T