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Home My WebLink AboutInsurance Certificate: Pacific Paving .- , " CITY RECORDER .r::' A CORD~ CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDtvyyy) 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 RIG HTS UPON THE C ERTIFICA TE 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: DeveloDers Sure tv & Indem INSURER c: PO Box 2370 INSURER 0: 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. NOlWlTHSTANDING 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. A" RE"ATE LIMITS SHOWN MAY HAVE B""N REO"CED BY pAin rLAIMS, I,N~: I~~~~ TYPE OF INSURANCE POLICY NUMBER PJ>,N~~~~~68,w~ Pg~!fJI~~~t~.gN LIMITS ~NERAl LIABILITY EA"H ,........,..., ,oR"'N'-'e $ 1,000,000 X COMMERCIAL GENERAL LIABILITY ~~~~~J9,,~ENTEr? n $ 300,000 A I CLAIMS MADE [!] OCCUR DTC0526D8417TIL09 3/20/2009 3/20/2010 MED EXP IAn" one "arson' $ 5,000 f- PED"'^NA . ADV INJURV $ 1,000,000 f- GENERAL AGGREGATE $ 2,000,000 ~'L AGG~EnE LIMIT AAES PER; PRt'"\nllrT<:: _ rOMP/OP Ar..r.. $ 2,000,000 X POLICY P~Pi LOC ~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 ~ ANY AUTO (Eaaccident) A f- ALL OWNED AUTOS DT810526DB417TIL09 3/20/2009 3/20/2010 BODILY INJURY (Per person) $ f- SCHEDULED AUTOS f- HIRED AUTOS BODilY INJURY (Peraccjd~nl) $ f- NQN-QWNED AUTOS f- PROPERTY DAMAGE $ (Peraccidenl) ~~GE LIABILITY AUTO QNL Y - EA ACCIDENT $ ANY AUTO OTHER THAN EA Arr $ AUTO ONLY: AGG $ ili~SS1UMBRELLA LIABILITY o.OU $ 1,000,000 X OCCUR D CLAIMS MADE AGGREGATE $ 1, 000,000 $ A ;1 ~EDUCTIBLE DTSMCUP526D8417TIL09 3/20/2009 3/20/2010 $ X RETENTION $10,000 WORKERS COMPENSATION AND l~WCSTATU-,l IOTH- EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ OFFICERJMEMBER EXCLUDED? EL DISEASE - EA EMPLOYEE $ If yes, describe under SPECIAL PROVISIONS below EL DISEASE. POLICY LIMIT $ B OTHER Contractors 786018C 7/1/2008 7/1/2011 Limit: $20,000 Corrunercial License Bond DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDEO BY ENDORSEMENT/SPECIAL PROVISIONS Certificate holder included as additional insured per attached endorsement #CGD2460805 where required by written contract. Subject to policy terms, conditions and exclusions. CERTIFICATE HOLDER CANCELLATION (541) 488-5320 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE The City of Ashland, its officers, agents EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL and employees 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT 90 North Mountain Avenue - Ashland, OR 97520 FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINO UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES, AUTHORIZED REPRESENTATIVE _~.u/~ S Wilson, AAI, AIC/SU S' ACORD 25 (2001/08) INS025 (0108).08a @ACORD CORPORATION 1988 Page 1 of2 COMMERCIALGENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED. (CONTRACTORS) This endorsement modifies insurance provided under the following: eOMMERCIAL GENERAL LIABILITY eOVERAGE PART 1. WHO IS AN INSURED - (Section II) is amended c) The insurance provided to the additional in- to include any person or organization thai you sured 'does not apply to "bodily injury" or agree in a "written contract requiring insurance" "property damage" caused by "your work" to include as an additional insured on this Cover- and included in the "products-completed op- age Part, but: erations hazard" unless the "written contract a) Only with respect to liability for "bodily injury", requiring insurance" specifically requires you "property damage" or "personal injury"; and to provide such covemge for that additional insured, and then the insurance provided to b) If, and orly to the extent that, the injury or ihe additional insured applies only io such damage is caused by acts or omissions of "bodily injury" or "property damage" that oc- you or your subcontractor in tne performance curs before the end ofthe period of time for of '''your work" to which the "written contract which the "written contract requiring insur- requiring Insurance" applies, The person or ance" requires you to provide such coverage org~nization does not qualify as an addit.ion~1 or the end of the policy period, whichever is insured with respect to,the independent acts earlier. or omissions of such person or organization, 3, The insurance provided to the additional insured 2. The insurance provided to the additional insured by this endorsement is excess over any valid and by this endorsement is limited as follows: cOllectible "other insurance", whether primary, a) In the event that the Limits of Insurance of excess, contingent or on any other basis, that is thi~ Covp.r"op. P"rt ~hown in thp. [)p.r.I"r"tion~ ,available to the additional insured for a loss we exceed the iimits of liability required by the cover under this endorsement. However, if the "written contract requiring insurance", the in- "written contract requiring insurance" specifically surance provided to the additional insured 'requires that this insurance apply on a primary shall be limited to the limits of liability re- tJa~i~ or a ~rirnary aml lIulI,culllritJulory tJa~i~, quired by that "written contract requiring in- this insurance is primary to "other insurance" surance". This endorsement shall not in_available to the additional insured which covers crease the limits of insurance described in that pers6n or organization 'as.8 named insured Section ill- Limits Of Insurance. for such ioss, 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 "otner 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". b) The insurance provided io 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 spccificiltions;- and' II. Supervisory, inspection, architectural or engineering activities. 4. A.~ " r.onrtitlon nf r.ovp.r"oP. rrovirtp.rt to thp. additional insured by th,is endorsement: 'a) The additional insured must give us written notil"'p' AF> F>oon .~F> rr~r.tjr::1hlp. of :m "nr.r:llr_ rence" or an offense which may result in a claim. To the extent possible, such notice should include: CG D2 46 08 05 @2005 The,Sl. Paul Travelers Curnpanies,lnc. Pay" 1 uf 2 .. COMMERCIAL GENERAL LIABILITY I. How; when endwhercthe "occurrence" or offense took place; II. The nam~s and addresses of any injured persons 'ond witnesscs; and III. The nature and location of any injury or damage arising out of the "occurrence" or offense. b) If a 'clalm is made: or "suit" Is brought against the additional insured, the additional insured must: I. Immediately record the specifics of the claim or "suit" and the date received; and It Notify us as soon as practicable. The additional insured must see to it that we receive written notice of the claim or "suit" as ::iuurli:t::i'J.lrcu;UcClultl, c) The additional insured must immediately send us copies of all legai papers received In conilectlon with the ciai'm or "suit", cooperate with us in the investigation or settlement of the claim or defense againsl the "suit", and otherwise 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 insuroncc" which wouid cover the additional insured f()r 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 orga[1ization as a named insured as' described in paragraph 3. above. 5. . The followin9 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 "personai injury" is caused by an offense,committed: a, After the Signing and 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 of 2 @ 2005 Tile 81. Paul Traveler,; Companie,;, Inc. CG 02 46 08 05