HomeMy WebLinkAboutInsurance Certificate: Adroit Development
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ACORD. CERTlFICA TE OF LIABILITY INSURANCE I DAlE (MMJODIYYYY)
~.. 6/4/2010
PRODUCER (541)772-1111 FAX: (541) 772-3785 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMAll0N
Beecher carlson Xnsurance Agency LLC ONLY AND CONFERS NO RIGHTS UPON THE CERllFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
707 Mu.:o:phy Rd ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Medford OR 97504 INSURERS AFFORDING COVERAGE NAlC#
INSURED INSURERAAmerican Safety :Insurance CO
Adroit Development Co J:nc INSURER B_ SAI!" 520112
PO Box 936 INSURER c: Wes tern Surety Caapany
INSURER D
Ashland, OR 97520 INSURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE 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 BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OFSUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ~ POLICY ~MBER &ffe~~J~~ ~~Mi.XJ;~ UMlTS
LTR
~NER6.L L1.&8IUTV EACH aCCURI'<ENCE , ~ 000 000
X COMMERCLAL GENERAL. LIABILITY I ~~C~~J~E~;~~;>~mce\ I 5D DOD
A I CLAIMS MADE [X] OCCUR SL0141560904 7/1/2D10 7/1/2011 MED EXP (Anyone person) I EXCLUDED
"- PERSONAL & ADV IN..lIRY I 1 DDO ODO
"- GENERAL AGGREGATE I 2 000 ODO
@'L AGG~EnEILlMIT APPr~t PER: PRODUCTS - COMP/OP AGG I 2 OOD 000
X POLICY Pf~; LOC
~OMOBR..E UABlllTY COMBNED SINGLE lIMIT I
(Eaaccident)
"- M-IY AUTO
"- ALL OWNED AUTOS BODILY INJJRY
I
"- SCHEDULEO AUTOS (Perpe~onl
"- HIRED AUTOS BODILY INJJRY
I
NON-O'v\NED AUTOS (Peracddenl)
"-
"- PPOPEPTY D/lMAGE I
(Peracddent)
RRAGE L1ABlUlY AUTO ONLY - EAACCIDENT I
PNY AUTO OTHER THPN EA/'CC I
AUTO ONL v: AGG I
DESS I UMBRELLA LIABILITY EACH OCCURRENCE I
OCCUR 0 CLAIMS MADE AGGREGATE I
.
R OEDUCTIBLE I
RETENTION I I
B WORKERS COMPENSA110N I. v.c STATU, I 10J~'
AND ~M~LOY~1'\3. LlAI5ILlTY Y/N
Ar>N' PROPRIETORIPARTNERIEXEOJTIVE D EL EACH ACCDENT I 500 OOD
OFFICERlMEt.'BER EXClUDED? b66512 10/1/2010
IMancbd:oryinNH) 10/1/20D9 E.L. DISEASE. EA EMPLOYE I 5DO 000
If yes. descnbe under 500 000
SPECIAL PROVISIONS below E,L. DISEASE - POLICY LIMIT I
C OTHERBOL IBond 8637467 10(31/2D09 10(31/2D10 Limit: $30,ODO
(Prevailing Wage)
DESCRIPTION OF OPERATIONS I LOCA.TIONS IVEHICLEG I EXCLU610NS ADDED BY ENDORSEMENT/ SPECIAL PROVl610N6
Re: Snowberry Brook Project, 350 Clay St, Ashland, OR 97520. Certificate holder included as additional insured
(excluding work comp) per attached endorsement ES98122100S where required by written contract. Subject to policy
terms, conditions and exclusions.
CERllFICATE HOLDER I r ,,:,\ it::': ,,;.,> fc'.~ n '\\ 11;e r.::;\ I
III ~ ' ,., ''=/'' .' .:' "-~ II \\
r-~---- ~ - 1
Ci ty of Ashland I II
20 East Main ! n ~
Ashland, OR 'M7520 JUN - 7 2010
U U'
I , I
I
CANCELLAll0N
SHOlLD ANY OFTHE ABOVE DESCRIBED POLICIES BECANCELLED BEFORE THE EXPlRA110N
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS YtftITTEN
N011CE TO THE CER11F1CATE HOLDER NAMED TO THE LEn, BUT FAILURE TO OOSO SHALL
IMPOSE NO OBLIGA110N OR LIABILITY OF Am KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTA11VES.
AUTHORIZED REPRESENTATIVE _ : C
5 Wilson, AAI, AIe/5U ~~.r... ~. Jt/~_
ACORO 25 (2009/01)
INSD25 1200901 )
e 1988.2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
,
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ASIC - ES 98 122 10 05
.ADDITIONAL INSlIRED ENDORS.EMENT- OWNERS, LESSEES OR CONTRACTORS
(MODIFIED FORM B)
(COMMERCIAL CONTRACTOR VERSION)
This Endorsement shall not selVe to increase our limits of insurance, as described in SECTION III -
LIMITS OF INSURANCE,
Name of Person or Organization: Project owners or general contractors, if other than a named insured, as well
as their directors, officers and employees where required to be named as an
Additional Insured in a written contract with the Named Insured entered into
prior to the loss or occurrence,
Effective Date: The later of the effective date of this policy or the dale on which "your work"
first started on the applicable project for which this Endorsement applies, but in
no event later than the policy expiration dele or applicable earlier termination
date of this policy.
In consideraton ottM payment at premiums, it is hereby
agreed that lhe following changes are incorporated into
the policy:
WHO IS AN INSURED (SECTION II) is amended to
include as an insured the person or organization
shown in the Schedule, but only with respect to
Iitlbility arising out of "your work" whic.h is performed
by the Named Insured for the Additional Insured Dn
or aRer the effective date of this Endorsement.
Coverage under lhis Endorsement applies only as
respects a legally enforceable written contract with ,the
Named Insured and only for li~iLlty. Mil;ing.Wll..llf.aL
relating to.-the Named Insured's negligence and only for
"hMily inj~ nr "rrnpertyJsmage- caused by an
"occurrence" Under CDverage A not otherwise excluded
in the policy to which lhis Endorsement applies,
This endorsement applies only to 'your work" on or at
"commercial construc:liDn projects", "Commercial
construction projects" are defined as buildings or
structures used solely for commercial use and not as
dwellings with 24--hour occupancy and or living quarters.
HOWever, bundings or stJ:uctures designed, built and
ES 98122 1005
maintained solely for the purpose as an "apartment
building or structure", shall be considered as
'commercial construction projeCts". An "apartment
bUilding or structure" is defined as a building or structure
with rooms or set of rooms fitted especially with
housekeepifig facilities which is self-ccntained and
where all of said rooms are legally leased or rented as a
mvelling or living ~p8ce.
If this policy includes a seW-insured retention or
deductible endon;ement, such endorsement shall apply
and affect our obligations pursuant to the policy,
.IL~..furth"r understood and agreed that irrespective of
the number of entities named as insureds under this
policy in no event shall the Company's limits of Iiabmty
exceed the limits of liability designated in the
Declarations.
All other terms, conditions and exclusions under the policy
are applicable to this Endorsement and remain unchanged,
Copyrighte 2005 American Safety Indemnity Company
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