HomeMy WebLinkAboutInsurance Certificate: Robert Jerome Keller
~ "
CITY RECORDER
'\
ACORD~ CERTIFICA TE OF LIABILITY INSURANCE DATE (MMiDDfYYYY)
11/20/2008
PRODUCER (541) 536-1726 FAX: (541)536-1568 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
LJ;ttle 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
L'a 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 o.
Merlin OR 97532 INSURER E:
THE POLICIES OF INSURANCE LISTED BELOVV HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOlWlTHSTANDING ANY
RECU!REMEtH, TERM OR CONDITlON OF ANY CONTRACT OR OTHER DOCUMENT WITH R!:SPECT 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.
, 000 , PAlO r"'''<
INSR ADO'L P8N~';~~j6g;r)y'1 P<fi~!fJ,~~~~\gN LIMITS
TYPE OF INSURANCE POLICY NUMBER
~NERAL LIABILITY I=ArH rY'rURRI=NrE $ 1,000,000
~ 5MMERCIAl GENERAL LIABILITY ~~~~~9E~~J~~enre\ $ 100,000
A CLAIMS MADE ~ OCCUR 44CL446596 10/10/2008 10/10/2009 MED EXP IAn ore ersonl $ 5,000
-
PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
-il~ AGG~nE ~~: nE~ PER: PRODUCTS - COMPIOP AGG $ 2,000,000
X POUCY JEeT LOC
~TOMOBILE LIABILITY COMBINED SINGLE LIMIT
(Eaaccldent) ,
- fW'fAUTO
- AlL O'hNED AUTOS BODILY INJURY
(Per person) $
- SCHEDULED AUTOS
- HIRED AUTOS BODilY INJURY
(Per accident) ,
- NON.OW'llED AUTOS fJl "Th s certificate
J ::~ f Insuranr.e
esen~ '"?ve oge currently PROPERTY DAMAGE $
--... - -, (Per accident)
l W J bel - .'.'- ..... - '"Ofl1I"or
QARAGE LIABILITY comptianc, AUTO ONLY - EA ACCIDENT $
=1 ANY AUTO with
IIIrltten contr ct." OTHER THAN EA Ace ,
any
ALITO ONLY: AGG $
aCEiSsr';tliE.P.cl.LA liABILITY - Ilcc=NC'" . , ,
:::J-OCCUR 0 CLAIMS MADE .... ....--.--
AGGRI=GATE
,
=1 ~EDUCTIBLE $
RETENTION !I;
WORKERS COMPENSATION AND I W;;STATU" I 10J~'
EMPLOYERS' LIABILITY
ANY PROPRIETORlPARTNERlEXECUTIVE El. EACH ACCIDENT $
OFFICEMvlEMBER EXCLUDED? EL DISEASE - EA EMPLOYE $
Ifye.., de!OCribe under
SPECIAL PROVISIONS below E.L. DISEASE. POUCY LIMIT $
OTHER
DESCRIPTION OF OPERATIONSIlOCATIONSlVEHIClEStEXCLUSlONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Ce~tlficate holder is listed as an additional insured per attached MP 97 67 04 08
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 KINO UPON THE
90 N Mountain Avenue
Ashland, OR 97520 INSURER, ITS AGENTS OR REPRESENTATIVES,
AUTHORIZED REPRESENTATIVE ~" ~... .,,-
Pam Dressler/BETH 6-
@)ACORD CORPORATION 1988
ACORD 26 (2001/08)
II'JS02oiC1Gcj,QGa
;;;;/U.-"?GJ'1,t)rCL~' .
aU:FiP h1.~?- ~
Page 1 ot2
."" ADDITIONAL NAMED INSUREDS
NAME (First Named & Other Named Insureds)
Southern Oregon Automatic Door Doing Business As
" Southern Oregon Automatic Door Doing Business As
Southern Oregon Automatic Door Doing Business As
OFAPPINF
COPYRIGHT 2000, AMS SERVICES INC
6\
c. The following is added to A.2. Property Not Covered of the BUILDING AND PERSONAL PROPERTY
COVERAGE FORM:
r. Property while stored or operated underground in connection with any mining operations,
d. The following is added to Paragraph 2. of B. Exclusions of the CAUSES OF LOSS - SPECIAL FORM:
n. We will not pay for loss or damage caused by puncture, blowout and road damage to tires and tubes mounted on
vehicles. However, we do pay for puncture, blowout or road damage caused by a specified peril.
0, We will not pay for loss caused by humidity, dampness, dryness or changes in or extremes of temperature.
p, We will not pay for loss caused by the weight of a load which, under the operating conditions at the time of a loss,
exceeds the registered lifting capacity of any equipment or machine.
q. We will not pay for loss due to theft or mysterious disappearance from any vehicle or attached container. We
will pay for loss due to burglary when there are signs of forcible entry to a locked vehicle or container.
e. E. 7. Valuation of the BUILDING AND PERSONAL PROPERTY COVERAGE FORM is deleted and replaced by the
following:
7. Valuation
We will determine the value of covered property in the event of loss or damage as follows:
a. At actual cash value at the time of the loss (with a deduction for depreciation) except as provided in
paragraphs b, and c, following.
b, Pair or Set. The value of a lost or damaged article which is part of a pair or set is based on a reasonable
proportion of the value of the entire pair or set. The loss is not considered a total loss of the pair or set.
c. Loss to Parts. The value of a lost or damaged part of an item that consists of several parts when it is
complete is based on the value of only the lost or damaged part or the cost to repair or replace it.
2. Rental Reimbursement
In the event of loss by a covered peril to covered contractors' equipment that you own, we will reimburse you for your
expense to rent similar equipment while your equipment is inoperable. The most we will reimburse you for rental
reimbursement expenses is $1,000. We will continue to reimburse you for the rental of equipment after the expiration
date of this coverage provided the loss occurred before the expiration date.
We will not reimburse you:
a. If you can continue or resume your operations with similar equipment that is available to you at no additional
expense to you: or
b, For the rental expense of any equipment unless you make every reasonable effort to repair, replace or rebuild the
inoperable equipment after the covered loss occurs.
3. With respect to this Additional Coverage, Contractors Equipment Coverage, Section D. Deductible of the BUILDING
ANDPEASONAL-PAOPERTY COVERAGE FORM is deleted and replaced by the following:
D. Deductible
We will not pay for loss or damage in anyone occurrence until the amount of loss or damage exceeds $500. We will
then pay the amount of loss or damage in excess of $500 up to the applicable limit of insurance.
We will not reimburse you for the rental of equipment until after 72 hours have passed since the covered property
was rendered inoperable. After 72 hours have passed, we will only reimburse you for the rental expense that you
actually incur.
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 LIABILITY COVERAGE FORM.
A. Blanket Additional Insured Coverage
1. SECTION 11- WHO IS AN INSURED of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM is amended to
include as an insured any person or organization (referred to as Additional Insured) whom you are required to add as an
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; and
Page 14 of 18
Includes copyrighted material of ISO Properties, Inc. and
American Association of Insurance Services, Inc., used with their permission
MP 97 67 04 08
" ~.
. .
c: When the written contract or agreement and certificate of insurance are currently in effect or becoming in effect
during the term of the policy and executed prior to the "bodily injury," "property damage," or "personal and
advertising injury,"
2. The insurance provided to the Additional Insured is limited as follows:
a. The Additional Insured is only an additional insured for:
(1) "Bodily injury," "property damage," or "personal and advertising injury" caused in whole or in part by negligent
acts or omissions of the Named Insured or anyone directly or indirectly employed by the Named Insured or for
whose acts a Named Insured may be liable.
(2) Liability arising out of your ongoing operations for the Additional Insured by or for you. A person's or
organization's status as an insured under this coverage ends when your operations for that insured are
completed.
b, The Limits of Insurance applicable to the Additional Insured are those specified in the written contract or agreement
but not more than the Limits of Insurance specified in the Declarations for this policy. The Limits of Insurance
applicable to the Additional Insured are inclusive of and not in addition to the Limits of Insurance shown in the
Declarations for the Named Insured.
3, In addition to the other exclusions applicable to Section I, Coverages A., B. and C. of the COMMERCIAL GENERAL
LIABILITY COVERAGE FORM, the insurance provided to the Additional Insured does not apply to:
a. "Property damage" to:
(1) Property owned, used, occupied by, loaned or rented to the Additional Insured;
(2) Property in the care, custody or control of the Additional Insured or over which the Additional Insured are for any
purpose exercising physical control; or
(3) "Your work" performed for the Additional Insured.
b. "Bodily injury," "property damage," or "personal and advertising injury" arising out of an architect's, engineer's or
sUNeyor's rendering or failure to render any professional services for you, for the Additional Insured or for others,
including, but not limited to:
(1) The preparing, approving or failure to prepare or approve maps, drawings, opinions, reports, surveys, change
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 (other
than service, maintenance or repairs) to be performed by or on behalf of the additional insured at the site of the
covered operations has been completed; or
(2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any
person cr organization other than another contractor or subcontractor engaged in performing operations for a
principal as a part of the same project.
4, SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, paragraph 4, Other Insurance, is amended to add
the following subparagraph:
d. Additional Insured's Other Insurance As Excess Insurance
To the extent required by an "insured contract," this insurance is primary on behalf ofthe Additional Insured; and any
other insurance maintained by the Additional Insured is excess and not contributory with this insurance. If the
"insured contract" does not require this provision, then paragraph a. above will apply,
: B. Mobile Equipment Broadened Coverage
V.12.f.(1) of the COMMERCIAL GENERAL LIABILITY COVERAGE FORMis xeplaced by the following:
(1) Equipment designed primarily for:
(a) Snow Removal;
(b) Road maintenance, but not construction or resurfacing; or
(c) Street cleaning.
Except the above provisions do not apply to self-propelled vehicles of less than 1 ,000 pounds gross vehicle weight which
are not intended for use on a highway.
: C. Aggregate Limit Per Project
The General Aggregate Limit under SECTION 11I- LIMITS OF INSURANCE of the COMMERCIAL GENERAL LIABILITY
COVERAGE FORM applies separately to each of your projects away from premises owned by or rented to you.
,.MP 9767 04 08
Includes copyrighted material of ISO Properties, Inc. and
American Association 01 Insurance Services, Inc., used with their permission
Page 15 of 18