HomeMy WebLinkAboutInsurance Certificate: Eselin Concrete for Hunter Park
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ACORD'" CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDIYYYY)
~ 1/6/2011
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 COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BElWEEN 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 terms 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 ondorsement(s}.
PRODUCER ~~~~~CT Cathy Damstra-Lepley, CIC
Beecher Carlson Insurance Agency LLC I r.~gN.r" 'ri" (541) 772-1111 I r..e~ No: (541) 712-3785
707 Murphy Rd ~D~~~ss: oa thy. damstralepley@beechercarlson.com
PRODUCER 00005367
Medford OR 97504 INSURER/51 AFFORDING COVERAGE NAICI
INSURED INSURER A :Contractors Bondina & Ins Co 37206
INSURER 8 :Travelers Casual tv Ins Co of 19046
ESELIN CONCRETE CONSTRUCTION, INC INSURER C :SAI F 52412
800 CHERRY ST INSURER 0 :
INSURER E :
MEDFORD OR 97501 INSURER F :
COVERAGES
CERTIFICATE NUMBER'2010 GL, SA & WC
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. NOTV\llTHSTANDING 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 H~REIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOINN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE ~~~; I~~~ ~St'5gTv~1 POLICY EXP LIMITS
LTR POLICY NUMBER MMlDDfYYYY
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
-
~ 5MMERCIAL GENERAL LIABILITY ~~~~~~J?E~~uE~nce $ 300,000
A CLAIMS-MADE [i] OCCUR X PllPH902901 4/17/2010 4/17/2011 MEO EXP (Anyone person) $ 5,000
-
X $500 Deductible PERSONAL & AOV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
-il'~ AGG~EnE ILlMIT APnS PER PRODUCTS - COMP/OP AGG $ 2,000,000
X POLICY ~~,Qi LOC , $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
- {Ea accident)
~ Am AUTO BODILY INJURY (Per person) $
B ALL OVvNED AUTOS BA7224P93710SEL 4/17/2010 4/17/2011
- BQDIL Y INJURY (Per accident) .
- SCHEDULED AUTOS PROPERTY DAMAGE
$
f- HIRED AUTOS (Per accident)
NON-Olf./NED AUTOS Uninsured motorist combined $
f-
$
f- UMBRELLA L1AB H OCCUR EACH OCCURRENCE $
EXCESS L1AB CLAIMS-MADE AGGREGATE $
r- DEDUCTIBLE .
RETENTION $ .
C WORKERS COMPENSATION X I we STATU_ IOJ6'-
AND EMPLOYERS' LIABILITY V'N
ANY PROPRIETORlPARTNERIEXECUTIVE D E.L. EACH ACCIDENT $ 500 000
OFFICERlMEMBER EXCLUDED? N" 15/1/2010 /1/2011
(MandatorylnNH) 965290 E.L. DISEASE - EA EMPLOYE $ 500 000
~~~~~~~cr~ ~~PERATIONS below E.L. DISEASE - POLICY LIMIT $ 500 000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Addltlonal Remarks Schedule, If more space Is required)
Certificate holder included as additional insured as respects general liability where required by written contract per
the attached endorsement. This form is subject to policy terms, condi tions, and exclusions.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOnCE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Ashland
20 East Main Street AUTHORIZED REPRESENTATIVE
Ashland, OR 97520
C Damstra-Lepley, CIe ~Q~~
ACORD 25 (2009/09)
INS025 (200909)
@ 1988-2009 ACORD CORPORA nON. All fl9hts reserved.
The ACORD name and logo are registered marks of ACORD
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BLANKET ADDITIONAL INSURED
This endorsement modifies insurance provided under the foliowing:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Section II - Who Is An Insured is amended
to include as an additional insured any per,
son or organization for whom you are per,
fonning operations when you and such per,
son or organization have agreed in writing in
a contract or agreement that such person or
organization be added as an additional in-
sured on your policy. Such person or organi,
zation is an additional insured only with re-
spect to liability for "bodily injury", "property
damage" or "personal and advertising injury"
caused by your negligence in the perform-
ance of your ongoing operations performed
for that additional insured. A person's or or-
ganization's status as an additional insured
under this endorsement ends when your op-
erations for that additional insured are com-
pleted.
B. With respect to the insurance afforded to
these additional insureds, the foliowing addi-
tional exclusions apply:
This insurance does not apply to:
1. "Bodily injury", "property damage" or
"personal and advertising injury" arising
oul of the rendering of, or the failure to
render, any professional architectural,
engineering or surveying services, in-
cluding but not Iimiled to:
a, The preparing, approving, or failing
to prepare or approve, maps, shop
drawings, opinions, reports, surveys,
field orders, change orders or draw-
ings and specifications; or '
b. Supervisory. inspection. architectural
or engineering activities.
2. "Bodily injury" or "property damage" oc-
curring after:
a. AIi work, including materials, parts or
. equipment furnished in connection
with such work, on the project (other
than service, maintenance or re-
pairs) to be performed by or on be-
half of the additional insured(s) at
the location of the covered opera-
tions has been completed; or
b. 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 subcon-
tractor engaged in perfonning opera-
tions for a principal as a part of the
same project.
3. "Bodily injury" or "property damage" oc-
curring or commencing before:
a. Execution of the written contract or
agreement that such person or or-
ganization be added as an additional
insured on your policy.
CBGL 00 410606
Contains Copyrighted Malerial of
ISO Properties, Inc., with permission
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