HomeMy WebLinkAboutInsurance Certificate: Fullerton & Company
~
~R " CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYVY)
OP 10 KW 12/01/10
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGEAFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the tenns and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER NAME:
Fullerton & Company AlC',""NcO, Extl: Ir~.Nol:
p, 0, Box 2901B ADDRESS:
Portland OR 97296-9018 CUSTOMER 10 II: ECONO-1
Phone: 503-274-6511 Fax: 503-274-6524 INSURER(S) AFFORDING COVERAGE NAIC#
INSURED INSURER A : American Economy Insurance Co. 19690
Economic & Financial Analysis INSURER B :
Raogond Bartlett
14 9 Franklin Street #201 INSURER C :
Vancouver WA 98660-2824 INSURER D :
INSURER E :
INSURER F :
COVERAGES
CERTIFICATE NUMBER:
REVISION NUMBER:
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAlO CLAIMS.
I~f: TYPE OF INSURANCE INSR WVD POLICY NUMBER (M~~;Y~Yv) (~~%Jv~~) LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1000000
-
A X COMMERCIAL GENERAL liABilITY 02BP2947526 12/28/09 12/28/10 I ~~~~~~s (Ea occurrence) , 1000000
l CLAIMS-MADE ~ OCCUR MED EXP (Anyone person) , 10000
- X PERSONAL & ADV INJURY , 1000000
~ GENERAL AGGREGATE , 2000000
~'L AGG~En~L1MIT APPlS PER: . PRODUCTS - COMPIOP AGG , 1000000
POLICY r;~& LOC ,
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ,
- (Eaaccldenl)
- ANY AUTO BODilY INJURY (Per person) ,
-
- ALL OWNED AlJTOS BODilY INJURY (Per accident) ,
I- SCHEDULED AlJTOS PROPERTY DAMAGE
,
I- HIRED AUTOS (Per accident)
NON-OWNED AlJTOS ,
I-
,
UMBRELLA L1AB H ~CCUR EACH OCCURRENCE ,
I-
EXCESS lIAB CLAIMS-MADE AGGREGATE ,
I- DEDUCTIBLE ,
RETENTION , ,
WORKERS COMPENSATION ITORYUMITS I IUER-
AND EMPLOYERS' LIABILITY VIN
ANY PROPRIETOR/PARTNERlEXEClJTIVt=J " E.l. EACH ACCIDENT ,
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH) E.l. DISEASE _ EA EMPLOYE ,
~r&:~~rb~ ~~dgPERATlONS belOVo' E.l. DISEASE - POLICY LIMIT ,
PROPERTY 29000
DESCRIPTION OF OPERATIONS I LOCATlONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is r~red)
Citt of Ashland is included as an Additional Insured as regar operations
of he.Named Insured ~7 ~olicy terms, conditions and exclusions and per
attached form BP8191 6 0
CERTIFICATE HOLDER
CANCELLATION
City of Ashland
Attn Mike Faught
Public Works Director
20 E Main St
Ashland OR 97520
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITYASH THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATNE
,
ACORD 25 (2009/09)
All rights reserved,
*_. REPRINTED FROM THE FORMS LIBRARY .-.
BP 81 91 06 06
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - BY WRITTEN CONTRACT, WRITTEN
AGREEMENT OR PERMIT
BUSINESSOWNERS COVERAGE FORM
This endorsement modifies insurance provided under the following:
The following is added to Paragraph C. Who is An
Insured in Section II - Liability:
4, Any person or organization for whom you are re-
quired by written contract, written agreement or
permit to provide insurance is an insured, subject
to the following additional provisions:
a, The contract, agreement or permit must be
in effect during the policy period shown in
the Declarations, and must have been exe-
cuted prior to the "bodily injury", "property
damage", "personal and advertising injury",
b, The person or organization added as an in-
sured by this endorsement is an insured only
to the extent you are held liable due to:
(1) The ownership, maintenance or use of
that part of premises you own, rent,
lease or occupy, subject to the following
additional provisions:
(a) This insurance does not apply to
any "occurrence" whiCh takes place
alter you cease to be a tenant in
any premises leased to or rented to
you;
(b) This insurance does not apply to
any structural alterations, new con-
struction or demolition operations
performed by or on behalf of the
person or organization added as an
insured:
(2) Your ongoing operations for that in-
sured, whether the work is performed
by you or for you:
(3) The maintenance, operation or use by
you of equipment leased to you by such
person or organization, subject to the
following additional provisions:
BP 81 91 06 06
Page I 012
(a) This insurance does not apply to
any "occurrence" which takes place
alter the equipment lease expires:
(b) This insurance does not apply to
"bodily injury" or "property
damage" arising out of the sole
negligence of such person or or-
ganization:
(4) Permits issued by any state or political
subdivision with respect to operations
performed by you or on your behalf,
subject to the following provision:
This insurance does not apply to "bodily
injury", "property damage", "personal
and advertising injury" arising out of op-
erations performed for the state or
municipality;
c, The insurance with respect to any architect,
engineer, or surveyor added as an insured
by this endorsement does not apply to
"bodily injury", "property damage",
"personal and advertising injury" arising out
of the rendering of or the failure to render
any professional services by or for you, in-
cluding:
(1) The preparing, approving, or failing to
prepare or approve maps, drawings,
opinions, reports, surveys, change or-
ders, designs or specifications: and
(2) Supervisory, inspection or engineering
services.
d, This insurance does not apply to "bodily
injury" or "property damage" included within
the "products-completed operations
hazard" .
e, A person's or organization's status as an in-
sured under this endorsement ends when
your operations for that insured are com-
pleted.
EP
.-- REPRINTED FROM THE FORMS L1BRARY.-."
f. No coverage will be provided if, in the ab-
sence of this endorsement, no liability would
be imposed by law on you. Coverage shall
be limited to the extent of your negligence
or fault according to the applicable principles
of comparative fault
g, The defense of any claim or 'suit" must be
tendered as soon as practicable to all other
Page 2 of 2
insurers which potentially provide insurance
for such claim or 'suit".
h, The insurance provided will not exceed the
lesser of:
(1) The coverage ancVor limits of this policy,
or
(2) The coverage ancVor limits required by
said contract, agreement or permit