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HomeMy WebLinkAboutInsurance Certificate: JBR Enviromental Consultants ~ OP 10: JN ACORD' CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDOfVYYY) ~ 02/09/11 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 AI. TER THE COVERAGE AFFORDED 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 pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subJoctto the tenns and conditions of the policy, cem:.~~B~.OIiCles may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsemen s. PRODUCER 801-486-1373 CONTACT NAME: O~mpus Insurance Agency 801-485-6943 I rAH.9N~t .,...,. If~NOl: P Box 65608 Salt Lake City, UT 84165-D608 E.MAIL ADDRESS: F. David Child. Jr. ~~~~,!!~~~ 0': JBRC01 0 INSURERlSl AFFORDING COVERAGE NAIC . INSURED JBR Environmental Consultants, INSURER A: Hartford Insurance Comcanv 22357 Inc INSURER B: Westchester Sumlus Lines Ins. 10172 8160 South Highland Drive A-4 INSURER C : Sandy, UT 84093 INSURER 0 : 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 PAID CLAIMS. I~~: TYPE OF INSURANCE B l,l'OLlCY EFF POLICY EXP LIMITS POLICY NUMBER M MIDDIYYYY MMIDDIYYYY GENERAL. LIABILITY EACH OCCURRENCE , 2,OOO,00C - B ~ 5MERCrAL. GENERAL. LIABILITY X X G22062815007 08104110 08104111 PREMJSE Eaocx:urrence1 , 50,001 CLAIMS-MADE [!] OCCUR . 5,001 - MED EXP (Anyone cerson) , B ~ Pollution L1ab. G22062815007 08104110 08104111 PERSONAL. & ADV INJURY , 2,000.001 B ~ Prof L1ab elms Ma G22062815007 08/04/10 08/04/11 GENERAL AGGREGATE , 2,000.001 ~~AGG:rilEILlMIT APPlS PER: PRODUCTS - COMPIOP AGG , 2,000,OOC PQUCY X I ,:,~,g: lOC , AUTOMOBILE llABlUTY COMBINED SINGLE UMJT , 1,000,001 - (Eaaccident) A ~ I#( AUTO 34UECNJ7738 08/04110 08/04/11 BODILY INJURY (Per person) , - All OWNED AUTOS BODilY INJURY (Per accident) , - SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) , - - NON-OWNED AUTOS , , UMBRELLA LlAB H OCCUR EACH OCCURRENCE , - EXCESS LIAB ClAIMS-MADE AGGREGATE , - DEDUCTiBLE , RETENTION , , WORKERS COMPENSATION I WCSTATU" I IOJ~- AND EMPL.OYERS' LIABILITY VIN ANY PROPRIETORJPARTNERlEXECUllVE 0 NIA E.l. EACH ACCIDENT , OFFICERlMEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE - EA EMPLOYE , ~~;~~O~ 'b~PERATIONS balON E.L. DISEASE - POLICY LIMIT , DESCRIPTION OF OPERATIONS I L.OCATIONS I VEH1CLE1F\Attach ACORD 101, Additional Remarks Schedule, If more space is required) The City of Ashland, OR and its elected 0 Icials, officers and employees are listed as additional insured as per written contract. Insurance is primary & non-contributo~ as ~er written contract. Waiver of subrogation ~~E!ieS as .E."!,~~~r .Co~~ ract Tho:, ~g....~~y a~rees to giv~!o~ days written n . ce in th yen f cellation. 0 a s no ice for non. cancellation CERTIFICATE HOLDER CANCELLATION CITYASH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRA TIO~ DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 E. Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE ;:r;A.;t dtf/ F. David Child, Jr. , ACORD 25 (2009/09) @1988.2009ACORDCORPORATION. All rights reserved. The ACORD name and logo are, registered marks of ACORD Named Insured Endorsement Number JBR Environmental Consultants. Inc. Policy Symbol I Polley Number I Policy Period Effective Date of Endorsement EPW G22062815 007 08/04/2010 TO 08/04/2011 Issued By (Name of Insurance Company) Westchester Surplus Lines Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequenllo the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ENDORSEMENT - OWNERS, LESSEES OR CONTRACTORS (PRIMARY AND NON-CONTRIBUTORY) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE CONTRACTOR'S POLLUTION LIABILITY COVERAGE SCHEDULE: Name of Person or Oroanization' Any person or organization that is an owner of real property or personal property on which you are performing operations, or a contractor on whose behalf you are performing operations, and only at the specific written request of such person or organization to you, wherein such request is made prior to commencement of operations. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) SECTION II - WHO IS AN INSURED is amended to include: A. SECTION II - WHO IS AN INSURED is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your ongoing operations perfonned for that insured. B. With respect to the insurance afforded to these additional insureds, the following exclusion is added: 2. Exclusions This insurance does not apply to bodily injury or property damage occurring after: (1) All work, including materials, parts or equipment fumished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additionai insured(s) at the site of the covered operations has been compieted; 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 a part of the same project. C. The coverage provided hereunder shall be primary and not contributing with any other insurance available to those designated above under any other third party liability policy. ENV-3101 (08-04) Includes copyrighted material of Insurance Services Office, Inc. with its permission Page 1 of 1 ....... ...... EncIorument Nl.mber JBR Environmental Consultants, Inc. Polley Symbol I PdIcy Nl.mbor IPdlcyPerlod Effecllwl Oabt of Endoraemont EPW G22062815 007 0810412010 TO 0810412011 latutel By (Name of Insurance Ccrnpany) Westchester Surplus Lines Insurance Company Insert the poIiey nt.mber. The rematndlr cl the Infonn8Oon Is to be compIeIed only when thb endorsement Is Issued I1.lbaequsnt to the ptepal8!bn 01 the poBcy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ENDORSEMENT OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modlfles Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE CONTRACTOR'S POLLUTION LIABILITY COVERAGE SCHEDULE: NAma nf Pl!l!Inn or OmantzRtfon' Any person or organlzaUon that Is an owner of real property or personal property on which you are performing operations, or a contractor on whose behalf you are pelformlng operations. and only at the spec1fic written request of such person or organization to you, wherein such request Is made prior to commencement of operations. (If no entry appears above. Information required to complete this endorsement will be shown In the Declarations as applicable to this endorsement.) A. SECTION II - WHO IS AN INSURED Is amended to Include as an Insured the person or organization shown In the SChsdule, but only with respect to liability erlslng out of your ongoing operations performed for that Insured. B. WIth respect to the Insurance afforded to these sddltlonallnsureds, the following exclusion Is edded: 2. exclusions This Insurence does not apply to bodily Injury or property demage occurring after: (1) All work, Including materials, parts or equipment furnished In connection with such work, on the project (other then service. maintenance or repelrs) to be performed by or on behalf of the addIUonallnsured(s) at the slta of the covered operations has been completed; or (2) Thet portion of your work out of which tha Injury or damage arises has been put to Ita Intended use by any person or organization other than another contractor or subcontractor engaged In performing operations for a principal as a part of the same project. ENV-3100 (08-04) Indudes copyrighted material oIlnsu,"_ Servfoes Office. Ine. wllh 118 permission Pegelofl Named Insured Endorsement Number JBR Environmental Consultants, Inc. Policy Symbol T Policy Number T Policy Period Effective Date of Endorsement EPW G22062815 007 08/04/2010 TO 08/04/2011 . Issued By (Name of Insurance Company) Westchester Surplus Lines Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS POLLUTION LIABILITY COVERAGE PART SCHEDULE Name of Person or Oroanization' Any person or organization that is an owner of real property or personal property on which you are performing operations, or a contractor on whose behalf you are performing operations, and only at the specific written request of such person or organization to you. wherein such request is made prior to commencement of operations. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or your work done under a contract with that person or organization and included in the products-completed operations hazard. This waiver applies only to the person or organization shown in the Schedule above. All other terms and conditions remain the same. ENV-3143 (03-05) Includes copyrighted material of Insurance Services Office, Inc. with its permission Page 1 of 1 i~ : T ~~ ... .II:~Y lRAI ACCJRIY" ~. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. T II CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELC'" THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATI I OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed, If SUBROGATION IS WAIVED, subject to I terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to I> certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME ATTENTION: GAIL BLOXHAM I~.::g~;. ~yf\: I;AX l(ivcNo.l: RJ AHMAN COMPANY E-MAIL ADDRESS 7555 MARKET PLACE DR PRODUCER EDEN PRAIRlE MN 55344 CUSTOMER 10 # INSURER(S) AFFORDING COVERAGE NAICt INSURED INSURER A: Advantage Worken Compensation Insurance Company 10033 JBR ENVIRONMENTAL CONSULTANTS INe INSURER B: 8160 S IDGHLAND DR SANDY, UT 84093 INSURER C: INSURER 0: 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 PERIQ[ 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 PAID CLAIMS. w,. ADO' SU"" I>OUCYEFF POUCY EXP ". TYPE Of INSURANCE IN'" WVD POUCY MJMBER I'''''''''''''''' (MMIDDIYVVY) U.fTS ~NERAL UABlLITY EACH OCCURRENCE $ DAMAGE TO RENTED ~ D~ERCIAL GENERAl UA8I"TY pREMISES {~ach oc::currencel. $ ~ CLAIMS MADE D OCCUR MED EXP IAnv one .......sonl $ L PERSONAL & AOV INJURY $ L aENERALAGGREGATE . n~LAG:Rn~IM~nSLPER PRODUCTS COMPJOP AGG $ pRO- POLICY JECT LOC AUTOMOBILE UABlUTY COMBINED SINGLE LIMIT (Eeec:cident) $ ANY AUTO BODILY INJURY Per ,~ . All OWNED AUTOS BODILY INJURY (Per accident) . f- SCHEDULED AUTOS PROpERTY DAMAGE $ HIRED AUTOS (Pereccident) NON-oWNED AUTOS $ $ UMBRELLA LlAB H ~CCUR EACH OCCURRENCE $ EXCESS LlAB CLAIMS MACE AGGREGATE $ DEDUCTIBLE $ RETENTION $ . WORKERS COMPENSATION I.WCSTATU-j I 10TH AND EMPLOYER'S UABIUTY 0 TORY LIMITS -ER ANY PROPRIETORIPARTNERI EXECUTIVE A OFFICERlMEMBER NfA 2163626 07/01/2010 07/01/2011 EXCLUDED? EL EACH ACCIDENT $1.000,000 (Mendatory In NH) EL DISEASE - EACH EMPLOYEE $1,000,000 Ifyes,desctibeunder -- DESCRIPTION OF OPERATIONS below El DISEASE - POUCY LIMIT $LOOO.OOO DESCRIPTION OF OPERATIONS I LOCATIONS' VEtDCLES (Attach ACORD 101, Addltional Rernartcs SchlXlule, If more space Is required) Oregon CERTIFICATE HOLDER CANCELLATION CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE 20 E MAIN STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ASHLAND, OR 97520 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRES "J/ ~LI-~~ --- !!J,.. ACORD 25 (20CMMl9) @1988-2009ACORDCORPORATlON,ADrightsltl$8Mtd. Tho ACORD name and logo are registered mar1cs of ACORD. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 1st Reprint Effective April 1, 1984 Advisory WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule A blanket waiver of subrogation is granted for all projects and contracts for the below named insured and it's subsidiaries for all jobs requiring such a waiver in writing. This waiver is effective 07/01/2010 to 12:01 AM on 07/01/2011 unless the policy is otherwise canceled. Operations Involved: This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. Endorsement Effective: 07/01/2010 Expiration Date: 07/0112011 Policy No. 2163626 Endorsement No.1 Insured: JBR ENVIRONMENTAL CONSULTANTS INC 8160 S HIGHLAND DR SANDY UT 84093 Premium $ Adjusted at Audit Insurance Company Advantage Workers Compensation Insurance Co 1983 National council on Compensation Insurance 81963 National Council on Compensation Im;uranClll.