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Home My WebLink AboutInsurance Certificate: Johnny Cat A CORDm CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY) 3/3/2009 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 9 7 5 04t', f'''''' ("\ ':;"" .~:. , r'~'~""', INSURERS AFFORDING COVERAGE NAIC# INSURED ~ * ,.'.-, .',J lb.-~,.~ %; .~ i~"J INSURER A: North Pacific Insurance 23892 Johnny Cat Inc INSURER B: Indernni ty Company of CA MAR 1 0 2009 INSURER c: PO Box 89 INSURER D: Jacksonville OR 973'30~ 'i ",\..;' i~". ";v, !. ~ f'~ $'~ INSURER E: . "r-ro '''',<ri' "'1 '..00/'" ,~'J '",'; ~ .: ;.....~ ~,"""" 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. I~;: ADD'L POLICY EFFECTIVE POLICY EXPIRATION IIN~Rn TYPE OF INSURANCE POLICY NUMBER DATE IMM/DDIYY) DATE IMM/DDIYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 - ~~~~~~J9E~~~Ju~~nce) X COMMERCIAL GENERAL LIABILITY $ 100,000 A I CLAIMS MADE [!] OCCUR C04165696 3/5/2009 3/5/2010 MED EXP (Anv one oerson) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 I--- GENERAL AGGREGATE $ 2,000,000 I--- GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 nn PRO- n POLICY JEeT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 I-- (Ea accident) $ X ANY AUTO I--- 3/5/2010 A ALL OWNED AUTOS C04165696 3/5/2009 BODILY INJURY I--- (Per person) $ SCHEDULED AUTOS I-- I-- HIRED AUTOS BODILY INJURY $ (Per accident) I-- NON-OWNED AUTOS - PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ~ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH $ 2,000,000 ~ OCCUR D CLAIMS MADE AGGREGATE $ 2,000,000 $ A R DEDUCTIBLE C04165696 3/5/2009 3/5/2010 $ RETENTION $ $ WORKERS COMPENSATION AND I T"6~~IfJNs I IO~~- 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 BOLl Bond 741085C 3/22/2009 3/22/2010 Limit: $30,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/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 LGL40321107 where required by contract. Subject to policy terms, conditions and exclusions. CERTIFICATE HOLDER CANCELLATION City of Ashland and ODOT, its officers, employees and agents James Olsen - Engineering 20 East Main Street Ashland, OR 97520 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 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE S1i#(~ ~* H/~ 3 Wilson, AAl, AlC/3D ACORD 25 (2001/08) INS025 (0108).08a @ ACORD CORPORATION 1988 Page 1 of 2 COMMERCIAL GENERAL LIABILITY LGL 403211 07 BLANKET ADDITIONAL INSUREDS - CONTRACTORS This endorsement modif~es insurance provided under the forlowing: COMMERCJAL GENERAL LIABILITY COVERAGE PART 1. A. Section II ~ Who Is An Insured is amended to indude as an insured the following: 1. Any person or organization for whom you are performing operations when you and such person or organization have :IgMM In writing in a contract or :aorAE!ment that such person or organization be added as an additional insured on your policy. Such person or organization is an additionar insured only with respect to -bodily injury" or "property damage" diredly resulting from your ongoing operations for that additional insured, whether the work is performed b~ or for you. A person's or organization's status as an additional insured under this endorsement ends the earliest of when your operations for that additionar insured cease, when they are completed, or that particuJar part if '\tou r work" has been put to its intended use. 2. Any person or organization from whom you lease a premises when you and such person or organjzation 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 "bOOily inJUry" or "propeny damage" directly resulting from 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 thfs endorsement ends when their contract or agreement 'Nith 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 addit;onar insured to your policy, but only with respect to "bodily jnjury'l or "property damage" directly resulting from 8. Your ads or omissions: or b. The acts or omissions of those acting on your behalf; 'n the pelformance of your ongoing operations performed by you or on your behalf. B. With respect to the insurance afforded these additional insu reds, the following additional exclusions apply~ 1. The insurance afforded urK:ier Paragraph 1.A.1. and 1 A.3. of this endorsement does not apply to: -Bodily inju~", "property damage" 01 ~'personal and advertising inj.Arylt arising oui of the rendering of, or tne 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. SUp8Nisory, 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 aner you cease to be a tenant in that premises: b. To structural alterationsl new construction or demolition operations penormed by or on behalf of the person or organization from whom you lease the premises. C. Coverage is provided only to the extent that "bodily injury" or "property damage- is caused by you or others performing operations on your behalf. No coverage is provided if, in the absence of this endorsement. no liability would be imposed on you by raw. Insurance provided under this endorsement shall not exceed the lesser of: 1. The coverage and limits of this policy; or 2. The coverage and limits required by written contract. written agreement or permit. LGL 4032 11 07 C 841 02 Contains ISO cop~nghtp.rl material, wi1h its permission Copyright, Insurance Services Office. Inc., 2004 Page 1 of 2 D. Conditions 1. Duties In The Event Of Notice, Claim or Suit The following is added to paragraph 2.1 Duties In The Event Of Noticet Claim or Suit: An additional insured under this endorsement must comply with all provisions of this section. 2. Other Insurance With respect to insurance provided by this endorsement to an additional insured. paragraph 4. of Section IV - Commercial General Liability Conditions is deleted and replaced by the following: 4. Other I nsu ranee a. Primary Insurance If required by 'Mitten contract or written agreement, this insurance Ls pnmary ana we w\ll not seek contribuUon from any insurance held by the additional insured for damages we cover. b. Excesslnsurance If there is other vaUd and collectible insurance available to the additional insuredl other than insurance held by the additional insured, this Insurance Is excess over that insurance. In the event the additional insured has other coverage for an "occurrence- by virtue of also being an addit10nal insured on other policies, this Insurance is excess over those policies. 3. Waiver of Transfer of Rights of Recovery Against Others to Us Paragraph a., Transfer of Rights of Recovery Against Others to Us, is amended by the addition of the following: If required by written contract. agreement or permit, we waive any right of recovery we may have against an additional in~urcd above bccouoo of poymcnt:l we make for injury or damage .arising out of your ongoing operations or "your work" done under a contract with that person 01" organization. Page 20f2 E 487 Q2 Contains ISO copyrighted material, with its permission Copyright, Insurance Services Office. Inc., 2004 LGL 4032 11 07