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Home My WebLink AboutInsurance Certificate: Taylor Site Development .. .. ~ I DATE (MMIDOfYYYY) ACORD. CERTIFICATE OF LIABILITY INSURANCE OP lOOT 10/08/09 TAYL02C PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE United Risk Solutions, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR PO Box 936 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Medford OR 97501-0067 Phone: 541-245-1111 Fax:541-245-1112 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: American Fire Casual tv INSURER s" TaOlor Site Develo~ent Inc. INSURER c: . . 15 1 Sage Road6 SU1te B INSURER 0: Medford OR 975 1 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 NSRC TYPE OF INSURANCE POLICY NUMBER ~~~1MM/DDIYY DATE MM/DDrtYlr LIMITS ~NERAL LIABILITY EACH OCCURRENCE .1,000,000 A X COMMERCIAL GENERAL LIABILITY BKA53763040 10/08/09 10/08/10 PREMISES (Ea occurence) .100,000 I CLAIMS MADE [!] OCCUR MED EXP (Anyone person) .5,000 I- PERSONAL & AnV INJURY .1,000,000 I- GENERAL AGGREGATE '2,000,000 ti-l'L AGG~EnE LIMIT APAS PER PRODUCTS - COMPIOP AGG $2,000,000 X POLICY FJGgi- LOC ~TOMOBILE LIABILITY COMBINED SINGlE LIMIT $ 1,000,000 ANY AUTO BAA53763040 10/08/09 10/08/10 (Eaaccident) l- I- ALL OWNED AUTOS BODlL Y INJURY $ A ~ SCHEDULED AUTOS (Per person) ~ HIRED AUTOS BODILY INJURY $ ~ NON-OWNED AUTOS (Per accident} I- PROPERTY DAMAGE $ (Peraccidenl) RRAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EAACC $ AUTO ONLY: AGG $ OESSJUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR D CLAIMS MADE AGGREGATE $ $ , R DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND ITOV~i~l~:~S I lO~- EMPLOYERS' LlABILlTY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L DISEASE - EA EMPLOYEE $ ~~~~I~Lsp~~VIS?ONS below EL DISEASE. POLICY LIMIT .. ~j! i '-; r;:;'\ [ OTHER ~)r . . - : I \11 ,Inll nrT ~ n ?nnn II DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDEO BY ENDORSEMENT I SPEClAL PROVISIONS II! II.! .. . ~i Re: Operations of the Named Insured as respects to North Main Pump Stat1on. City of Ashland and Oregon Department of Transportation are an addi. t!.ional- -I in;ured per form CG83301203 attached. I CERTIFICATE HOLDER CANCELLATION CITAS01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN City of Ashland NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL 20 E. Main St. IMPOSE NO OBLIGATION OR LlABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Ashland OR 97520-1814 REPRESENTATIVES. AUTHO~R~PRE~~~6&::1 ACORD 25 (2001108) @ACORD CORPORATION 1988 ACORD. CERTIFICATE OF LIABILITY INSURANCE 9!A~L8ic T OAT;~M:;~~I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PRODUCER United Risk Solutions, Inc. PO Box 936 Medford OR 97501-0067 Phone: 541-245-1111 Fax:541-245-1112 Taylor Site Development Inc. 1501 Sage Road6 SU1te B Medford OR 975 1 INSURERS AFFORDING COVERAGE INSURER A: American Fire Casualty INSURER B: INSURER c: INSURER 0: INSURER E: NAIC# INSURED COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERlOD 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 POLlCIES_ AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L TR kNSRO TYPE OF INSURANCE POLICY NUMBER DATE MMIDOrl(lc P8k~E MM/DONY LIMITS ~NERAL LIABILITY EACH OCCURRENCE $1,000,000 A X COMMERCIAL GENERAL LIABILITY BKA53763040 10/08/09 10/08/10 PREMISES (E~~~~nce) $100,000 I CLAIMS MADE [!] OCCUR MEO EXP (Anyone person) $ 5,000 - PERSONAL & AOV INJURY $ 1,000,000 - GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2,000,000 Xl :n' PRO. n X POLICY JECT LOC ~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 ANY AUTO BAAS 37 63040 10/08/09 10/08/10 (Eaaccidenl) - - ALL OWNED AUTOS BODILY INJURY (Per person) $ A ..JC.. SCHEDULED AUTOS ..JC.. HIRED AUTOS BODILY INJURY (Peraccidenl) $ ..JC.. NON-OWNED AUTOS - PROPERTY DAMAGE $ (Peraccidenl) ~RAGE lIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EAACC $ AUTO ONLY: AGG $ .=JESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR D CLAIMS MAOE AGGREGATE $ $ R ~EOUCTIBlE $ RETENTION $ $ WORKERS COMPENSATION AND I TORY LIMITS I 10TH. ER EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERJEXECUTIVE E.L EACH ACCIDENT $ OFFICERlMEMBER EXCLUDED? E.L DISEASE - EA EMPLOYEE $ ~PEtl~t~~'Ov~s1o~s belC1W E.L DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCA nONS f VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT f SPECIAL PROVISIONS Re: Operations of the Named Insured. Certificate Holder is Additional Insured per form CG83301203 attached. CERTIFICATE HOLDER CANCELLATION THOEN01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Engineering, NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL Thornton Inc. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINO UPON THE INSURER,ITS AGENTS OR 1236 Disk Drive Suite 1 Medford OR 97501 REPRESENTATIVES. AUTHO~:~PRE~7~~ ACORD 25 (2001/08) @ ACORD CORPORA TIDN 1988 COMMERCIAL GENERAL LIABILITY CG83301203 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. GENERAL LIABILITY MASTER PAK @ This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART INDEX SUBJECT <(BLANKET ADDITIONAL INSURED (OWNERS, LESSEES, CONTRACTORS OR LESSORS) FIRE, LIGHTNING, EXPLOSION AND SPRINKLER LEAKAGE DAMAGE TO PREMISES YOU RENT PAGE 2 3 NON-OWNED WATERCRAFT 4 SUPPLEMENTARY PAYMENTS (BAIL BONDS) PERSONAL AND ADVERTISING INJURY - ELECTRONIC PUBLICATION EXTENSION 4 5 AGGREGATE LIMITS (PER LOCATION) AGGREGATE LIMITS (PER PROJECT) VOLUNTARY PROPERTY DAMAGE COVERAGE 5 5 6 OFF PREMISES CARE, CUSTODY OR CONTROL COVERAGE NEWLY FORMED OR ACQUIRED ORGANIZATIONS 6 7 DUTIES IN THE EVENT OF OCCURRENCE, OFFENSE, CLAIM OR SUIT 7 BODILY INJURY (MENTAL ANGUISH) WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS 8 8 v MEDICAL PAYMENTS 8 CG 83 30 12 03 Includes copyrighted material of ISO Properties, Inc., with its permission. ISO Properties, Inc., 2003 Page 1 of 8 1. BLANKET ADDITIONAL INSURED (Owners, Lessees, Contractors or Lessors) (Includes a Primary/Non,Contributory provision) Who Is An Insured, Section 11 is amended to include as an insured any person or organization whom you are required to name as an additional insured on this policy in a written contract or written agreement. The written contract or written agreement must be currently in effect or becoming effective during the term of this policy and executed prior to the "bodily injury," "property damage" or "personal and advertising injury." The insurance provided the additional insured is limited as follows: A. The person or organization is only an additional insured with respect to liability: 1. Arising out of real property, as described in a written contract or written agreement, that you own, rent, lease or occupy; or 2, Caused in whole or in part by your ongoing operations performed for that insured. The insurance provided the additional insured in 1.A.2. above does not apply to: a, Coverage A ' Bodily Injury and Property Damage Liability, Coverage B - Personal and Advertising Injury Liability or defense coverage under the Supplementary Payments arising out of an architect's, engineer's or surveyor's rendering of or failure to render any professional services including: (1) The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and (2) Supervisory, inspection, architectural or engineering activities. b, "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) were performed by or on behalf of the additional insured(s) at the site where the covered operations have 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 or organization other than another contractor or subcontractor engaged in performing operations for a principal as part of the same project. 8, The limits of insurance applicable to the additional Insured are those specified in a written contract or written agreement or the limits of Insurance as stated in the Declarations of this policy and defined in Section III _ Limits Of Insurance of this policy, whichever are less. These limits are inclusive of and not in addition to the limits of insurance available under this policy. C. The insurance provided the additional insured does not apply to the liability resulting from the sole negligence of the additional insured. CG 83 30 12 03 Includes copyrighted material of ISO Properties, Inc., with its permission. ISO Properties, Inc., 2003 Page20f8 D, As respects the coverage provided to the additional insured under this endorsement, Section IV, Conditions is amended as follows: 1. The following is added to Condition 2. Duties In The Event Of Occurrence, Offense, Claim, or Suit: An additional insured under this endorsement will as soon as practicable: a, Give written notice of an "occurrence" or an offense, that may result in a claim or "suit" under this insurance to us; b, Tender the defense and indemnity of any claim or "suit" to all insurers whom also have insurance available to the additional insured; and c, Agree to make available any other insurance which the additional insured has for a loss we cover under this Coverage Part. 2, The following is added to Condition 3. Legal Action Against Us: We have no duty to defend or indemnify an add~ional insured under this endorsement until we receive written notice of a claim or "suit" from the additional insured. 3. The following is added to Paragraph a., Primary Insurance of Condition 4. Other Insurance: ~ If the additional insured's policy has an Other Insurance provision making its policy excess, and a Named Insured has agreed in a written contract or written agreement to provide the additional insured coverage on a primary and noncontributory basis, this policy shall be primary and we will not seek contribution from the additional insured's policy for damages we cover. 4, The following is added to Paragraph b., Excess Insurance of Condition 4. Other Insurance: Except as provided in Paragraph 4.a. Primary Insurance as amended above, any coverage provided hereunder shall be excess over any other valid and collectible insurance available to the additional insured whether primary, excess, contingent or on any other basis. In the event an additional insured has other coverage available for an "occurrence" by virtue of also being an additional insured on other policies, this insurance is excess over those other policies, 2, FIRE, LIGHTNING, EXPLOSION AND SPRINKLER LEAKAGE DAMAGE TO PREMISES YOU RENT If Damage To Premises Rented To You under Coverage A is not otherwise excluded from this policy, the following applies: A. The last paragraph of 2. Exclusions of Section I .. Coverage A is replaced by the following: If Damage To Premises Rented To You is not otherwise excluded, Exclusions c, through n. do not apply to damage by fire, lightning, "explosion" or sprinkler leakage to premises while rented to you or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to this coverage as described in Section III, Limits Of Insurance. CG 83 30 12 03 Includes copyrighted material of ISO Properties, Inc., with its permission. ISO Properties, Inc., 2003 Page 3 of8