HomeMy WebLinkAboutInsurance Certificate: Cut N Break
... -.-
CITY RECORDER
ACORD~ CERTIFICA TE OF LIABILITY INSURANCE I DATE (MM,oDNYYY)
4/11/2008
PRODUCER (541)772-1111 FAX: (541)772-3785 THIS CERllFICATE IS ISSUED AS A MATTER OF INFORMAll0N
ONLY AND CONFERS NO RIGHTS UPON THE CERTlFICATE
Beecher carlson :Insurance Agency LLC HOL DER. THIS CERllFICATE DOES NOT AMEND, EXTEND OR
707 Mu:t:phy lid ALTER THE COVERAGE AFFORDEO BY THE POLICIES BELOW.
Med.t'ord OR 97504 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: American Hallmark :Ins Co 43494
Cut N Break Construction Ine INSURER B: SAI:F Corporation 54321
INSU>:lER c: Wes 'tern Sure'tv C'aDJ:loanv
PO Box 1455 INSURER D
Medford OR 97501 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 WiICH 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 IA.-!?D'L POLICY EFFECTIVE Pg~!flf~~':h~J.9N L.lI"lrn:
, TVrl: or INOUAANCl: roL.lCV NUMDl:11: OAT!!! MhltDDN'Y
~NERAL LIABILITY EACH OCCURRENCE , 1,000,000
X COMMERCLAJ.. GENERAl. LIABILITY B~b~~l?E~~~~enc~ $ 100,000
A 1 CLAIMS MADE [i] O(X:I JR 44CL44930202 4/13/2009 4/13/2010 "'000"' 0 I, 5 000
- PERSONAL & I-DV INJJRY I 1,000,000
- GENERAL AGGREGATE , 2,000,000
~.~ AGG~EnE LIMIT nE~ PER: p _ rnMPj()p Ar..r.. $ 2,000,000
POLICY r;.!?i LaC
~OMOBILE LIABILIlY COMBINED SINGLE LIMIT I 1,000,000
~ ANY AUTO (Eaacddenl)
A - ALLUVl1'lI:UAUIU::::i 44CL44930202 4/13/2009 4/13/2010 80DIL Y INJJRY
(Perpersonj ,
- SCHEDULED AUTOS
- HIRED AUTOS BODILY INJJRY I
(per accident)
- NON_O'^NED ."-'uTOS
- PROPERTY DilMAGE I
(Per accident)
GARAGE LIABILITY AUTO ONLY. ~ACCIDENT $
==i ANY AUTO OTHER THAN EAACC I,
AUTO ONLY AGG I
EXCESSIUMBRELLA LIABILlTV I ~"r:.; r'l(''rIIRR~tJr~ I
=:J OCCUR D CLAIMS MPDE AGGREGATE I
,
~ ~EOUCTlBlE $
nETENTION II: I,
B WORKERS COMPENSATION AND I. w:, STfJ~~ I IO'!,\"
EMPLOYERS' LlABILllY 500,000
ANY PROPRlETORIPAATNER!EXEC-JTIVE E,L. EACH ACCIDENT I
OFFICERIMEMBER EXCLUDED? 489003 10/1/2008 10/1/2009 E.L. DISEASE- EA EMPLOYEE $ 500,000
llyes.oesalOeunaer 500,000
SPECIAL PIWVISIONS t1Qlow EL DISEASE- POLICY LIMIT $
C OTHER Prevailing Wage 70106243 6/5/2008 6/5/2009 Limit: $30,000
(BOLI) Bond
DESCRIPTION OF OPERATIONS,\,OCATIONSNEHICLESJEXCLUSIONS ADDED BY ENDORSEMENT/sPECIAL PROVISIONS
Certificate holder included as additional insured (excluding work comp) per attached endorsement MP953S0305 where
required by written contract, Subject to policy terms, conditions and exclusions,
CERllFICATE HOLDER
CANCELLA 110N
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of Ashland EXPIRATION DA'" THEREOF, THE ISSUING INSURER 'MLl ENDEAVOR TO MAIL
Kari Olson 10 DAYS VwRfTTEN NOTICE TO THE CERTlFICATE HOLDER NAMED TO THE LEFT, BUT
90 N Mountain Ave -
Ashland, OR 97520 FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINO UPON THE
INSURER ITS AGENTS OR REPRESENTATlVES.
AUTHORIZED REPRESENTATIVE -c:::..- .~ ~
S wi L'O' on , AAI, AIC/STJ .=-'Y-'--- ,,-. UA'
ACORD 25 (2001/08)
INSD25 (0108).08a
<> ACORD CORPORA 110N 1988
Page 10/2
POLICY NUMBER:
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BLANKET'ADDITIONAL INSURED ENDORSEMENT
This endorsement modifies the insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
A. SECTION II - WHO IS AN INSURED is amended to include as an insured any person or organization
(referred to below as Additional Insured) whom yuu ~Ie le4uiled lu~dd as an additional Insured on this
policy under:
1. A written contract or agreement; and
2. Where a certificate of Insurance showing that person or organization as an addrtional insured has
been issued; and
3. When the written contract or agreement and the certificate of insurance are currently in effect or
bec~ming in effect during the term of the policy and e_xecuted prior to the "bodily illjUlY," "J..lruptl/Ly
damage" or "personal and advertising injury."
B. The insurance provided to the Additionallnsured(s) is limited as follows:'
1, The Additionallnsured(,;) i,; ullly ~Il ~ddiliull~1 insured for:
a, "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.
b. liabilitY arising out of your ongoing operations for the Additional Insured(s) by or for you. A
person's or organization's status as an insured under this endorsement ends when your
Opp.rRtions for that insured are completed.
2, The Limits oflnsurance applicable to the Additionallnsured(s) are those specified in the wrjtten
contract or agreement but not more than the Limits of Insurance specified in the Declarations of this
policy. The Limits of Insurance applicable to the Additionallnsured(s) are inclusive of and not in
addition to the Limits of Insurance shown in the Declarations for the Named Insured.
C, In addilion to the other exclusions applicable to Coverages A, B, and C; the insurance provided to the
Additionallnsured(s) does not apply to:
1. "Propeitydamage' to:
a. Property owned, used, occupied by, loaned.or rented to the Additionallnsur~<l(s);
b. Properly in the care, custody or control of the AdditionaUnsured(sj or over which the Additional
" Insured(s) are for any purpose exercising physical control: or
c. "Your work"performed for theAdditionallnsured(s).
2. "Bodily inJ~.JrY." "property damago" Of "personal 'and advertising inju'ry" arising out of an architect's,
engineer's or surveyo~s rendering or failure to render any professional services for you, for the
Additional Insured(s) or for others, including, but not limited to:
a~ The prep:uing, :::!J1proving or failure to prepare or approve maps, drawings, opinions, reports,
surveys, change orders, designs or specifications; or
b. Supervisory, inspection or engineering services.
3. "Bodily injury' or "properly damage' occurring after;
a. 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 Of' on behalf of the
additional insured(s) aUhe site of the covered operation. h~. hp.en completed: or
b, Thatportion of "your work" out of which the injury or damage arises has been put to its intended
use by any person or organization other than another contractor or subcontractor engaged in
performing operations for a principal as a part of the same project.<
MP 95 38 03 05
Includes copyrighted rnaterial of Insurance Services Office, Inc., with its permission.
Page 1 of 1