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HomeMy WebLinkAboutInsurance Certificate: Triad Mechanical .- ACORD. CERTIFICATE OF LIABILITY INSURANCE OP ID C9 DATE (MMIDOIYYYY) TRIAD-1 09/23/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Anchor Insurance - Portland HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1201 SW 12th Ave., Suite 500 ALTER THE COVERAGE AFFORDED BY THE POliCIES BELOW. Portland OR 97205-2030 Phone: 503-224-2500 Fax:503-224-9830 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:. Travelers Indemnitv CO. INSURER B: Travelers Prop Cas Co of Amer Triad Mechanicalp Inc. INSURER c: SAIF Corporation 1419 NE Lombard lace INSURER 0: Portland OR 97211-4061 INSURER E: COVERAGES 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. LTR NSR TYPE OF INSURANCE POLICY NUMBER PD~~E fMM/DDfYY1- DATE'IM,t~~~~N LIMITS GENERAL LIABILITY -:CH OCCURRENCE .1,000,000 - 10/01/09 10/01/10 AMA'GFTO , A X X COMMERCI/d. GENERAL LIABILITY DTC06583M600IND09 PREMISES (Ea occurance) .300,000 I CLAIMS MADE ~ OCCUR MED EXP (Any ona parson) $10,000 ~ WA STOP GAP BLANKET CONTRACTUAL PERSONAL & ADV INJURY .1,000,000 I-- $1,000,000 XC&U COVERAGE GENERAL AGGREGATE .2,000,000 GEN'l AGG~E~E LIMIT APAS PER: PRODUCTS - COMPIOP AGG .2,000,000 n X PRO- POLICY JECT LOC ~TOMOB1LE LIABILITY COMBINED SINGLE LIMIT .1,000,000 B X ~ ANY AUTO DT8106583M600TIL09 10/01/09 10/01/10 (Eaaccident) ALL OWNED AUTOS BODILY INJURY I-- . SCHEDULED AUTOS (Per person) I-- ~ HIRED AUTOS BODILY INJURY . ~ NON-OWNED AUTOS (Per accident) - PROPERTY DAMAGE . (Paraccidant) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT . =1 ANY AUTO OTHER THAN EAACC . AUTO ONLY: AGG . EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE .5,000,000 B :!J OCCUR 0 CLAIMS MADE DTSMCUP6583M600TIL09 10/01/09 10/01/10 AGGREGATE .5,000,000 - . ==J DEDUCTIBLE . RETENTION . . WORKERS COMPENSATION AND X ITbWyS~~Ti's I IOJ~- C EMPLOYl::RS'LIABILITY 811431 10/01/09 10/01/10 .500,000 ANY PROPRIETORJPAi-1.TNERIEXECUTIVE E.L, EACH ACCIDENT OFFICERlMEMBER EXCLUDED? OREGON E.L DiSEASE - EA EMPLOYEE , 500,000 If yes, describe under .500,000 SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES f EXCLUSIONS ADDEO BY ENDORSEMENT f SPECIAL PROVISIONS RE: WTP PRocess Improvements Project No. 2006-02 It is agreed that the City of Ashland, its officers, employees and agents are included as additional insureds as respects to General Liability and Automobile Liability, but solely in regards to work being performed by or on behalf of the Named Insured in connection with the project dexceibed herein where required under CERTIFICATE HOLDER CANCELLATION ASHLA-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCelLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ 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. AUT SE E CITY OF ASHLAND Attn: Morgan Wayman 51 Winburn Way ASHLAND OR 97520 ACORD 25 (2001/08) @ACORD CORPORATION 1988 q - ;;;'9 _0 9 _ SFS ':5hrk/tLJ I~~: /~i,4,t) H~C/1t#,?d5 u~c/ /<<st:G-Yc:?,;? Cp &r-h;;~ ,fcrV wC€kr (;~P'd- ?L/(/VT p/c:J;;d ~t.c5 -.#'''6,p _ . INSURED: Triad Mechanical, Inc. POLICY NUMBER: DT-CO-6583M600-IND-09 EFFECTIVE: 10/01/09 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED - (Section II) is amended 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 liabiiity 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 additionai 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 ii. Supervisory, inspection, architectural or engineering activities. CG 02 46 08 05 c) 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 insurance" specifically requires you to provide such coverage 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 eariier. 3. The insurance provided to the additional insured by this endorsement is excess over any valid and collectibie "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 "written contract requiring insurance" specifically requires that this insurance apply on a primary basis or a primary and non-contributory basis, this insurance is primary to "other insurance" 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. As a condition of coverage provided to the additional insured by this endorsement: a) The additional insured must give us written notice as soon as practicable of an "occur- rence" or an offense which may result in a claim. To the extent possible, such notice should include: @ 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY i. How, when and where the "occurrence" or offense took place; Ii. The names and addresses of any injured persons and witnesses; and iii. The nature and location of any injury or damage arising out of the "occurrence" or offense. b) If a ciaim 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 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 soon as practicable. c) The additional insured must immediately send us copies of all legal papers received in connection with the claim or "suit". cooperate with us in the investigation or settlement of the claim or defense against 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 insurance" which would cover the additional insured for a ioss 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 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 of2 @ 2005 The St. Paul Travelers Companies, Inc. CG 02 46 08 05 .. . . INSURED: Triad Mechanical, Inc. POLICY NUMBER: DT-810-6583M600TIL-09 EFFECTIVE: 10/01/09 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement. the provisions of the Coverage Form apply unless modi- fied by the endorsement. GENERAL DESCRIPTION OF COVERAGE - This endorsement broadens coverage. However. coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is exduded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BROAD FORM NAMED INSURED B. BLANKET ADDITIONAL INSURED C. EMPLOYEE HIRED AUTO D. EMPLOYEES AS INSURED E. SUPPLEMENTARY PAYMENTS - INCREASED LIMITS F. HIRED AUTO LIMITED WORLDWIDE COVERAGE -INDEMNITY BASIS G. WAIVER OF DEDUCTIBLE - GLASS PROVISIONS A. BROAD FORM NAMED INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II - LIABILITY COV- ERAGE: Any organization you newly acquire or form dur- ing the policy period over which you maintain 50% or more ownership interest and that is not separately insured for Business Auto Coverage. Coverage under this provision is afforded only un- til the 180th day after you acquire or form the or- ganization or the end of the policy period, which- ~ver is earlier. B. LANKET ADDITIONAL INSURED The following is added to Paragraph c. in A.1., Who Is An Insured, of SECTION II - LIABILITY COVERAGE: Any person or organization who is required under a written contract or agreement between you and that person or organization, that is signed and CA T3 53 06 09 H. HIRED AUTO PHYSICAL DAMAGE - LOSS OF USE -INCREASED LIMIT I. PHYSICAL DAMAGE - TRANSPORTATION EXPENSES - INCREASED LIMIT J. PERSONAL EFFECTS K. AIRBAGS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS M. BLANKET WAIVER OF SUBROGATION N. UNINTENTIONAL ERRORS OR OMISSIONS executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the poi icy period. to be named as an addi- tional insured is an "insured" for Liability Cover- _ . " age, but only for damages to which this insurance applies and only to the extent that person or or- ganization qualifies as an "insured" under the Who Is An Insured provision contained in Section II. C. EMPLOYEE HIRED AUTO 1. The following is added to Paragraph A.1.. Who Is An Insured. of SECTION " - LI- ABILITY COVERAGE: An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in that "employee's" name, with your permission. while performing duties related to the conduct of your busi- ness. @2009 The Travelers Companies, Inc. Includes the copyrighted material of Insurance Services Office. Inc. with its permission. Page 1 of 4