Loading...
HomeMy WebLinkAboutInsurance Certificate: JBR Enviromental Consultants (2) .----., OP 10: IN ACO~D. CERTIFICATE OF LIABILITY INSURANCE I DATE (MMfODN'YVY) ~ 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 ALTER 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(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 endorsementts'). PRODUCER 801-486-1373 CONTACT NAME: o~mpus Insurance Agency 801-485-6943 ~NJo_"'vtl' I r~~ Not: P Box 68608 Salt Lake City. UT 84166-0608 E-MAIL ADDRESS: F. David Child. Jr. ~n~~g~~~ ID #_JBRC01 0 INSURER/S AFFORDING COVERAGE NAIC. INSURED JBR Environmental Consultants, INSURER A: Hartford Insurance Comcanv 22357 Inc INSURER B: Westchester Surplus 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. II~,SR TYPE OF INSURANCE == POLICY EFF ~~~~~ LIMITS TR POLICY NUMBER M MIDDfYYYY GENERAL LIABILITY 2,000,001 I-:-:- EACH OCCURRENCE $ B X COMMERCIAL GENERAL LIABILITY X X G22062815007 08/04/10 08/04111 PREMISE Ea~~~nce\ $ 50,001 I CLAIMS-MADE ~ OCCUR MED EXP lAm one person) $ 5,001 B X Pollution L1ab. G22062815007 08/04/10 08/04111 PERSONAL & MJV INJURY $ 2,000,001 '-'-'- 2,000.001 B X Prof L1ab elms Ma G22062815007 08/04/10 08/04111 GENERAL AGGREGATE $ = 2,000,001 ~~ AGG~r~t LIMIT APnS PER: PRODUCTS. COMPIOP AGG $ POLICY X ~~g: LOC $ AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT $ 1,000,OOC X (Eaaccident) A ANY AUTO 34UECNJ7738 08104110 08104111 = BODILY INJURY (Per person) $ - ALL OWNED AUTOS BODILY INJURY (Per accident) $ - SCHEDULED ALTTOS PROPERTY DAMAGE $ - HIRED AUTOS (Per accident) - NON-OVoINED ALTTOS $ $ UMBRELlA L1AB H~UR EACH OCCURRENCE $ - EXCESS L1AB CLAIMS-MADE AGGREGATE $ - DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSA nON we STATU- IOJb'- AND EMPLOYERS' LIABILITY TIN ANY PROPRIETORIPARTNERJEXECUTlVE D NI. E.l. EACH ACCIDENT $ OFFlCERlMEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ ~~~~~~O~ 'b~'gPERAT10NS belcm E.L. DISEASE - POLICY LIMIT $ DESCRlPnON OF OPERATlONS , LOCA TlONS , VEHICL.E~Attach ACORD 101, AddItional Remlr1ul Schedule, .f more space Is requlrvd) The City of Ashland, OR and Its elected 0 Iclals, officers and employees are listed as additional Insured as per written contract Insurance Is ~\/ 8ECORDER primary & non-contributo:?; as ~r written contract. Waiver of subrogation - apGlies as per written con ract The agency ~n~r;es to give 30 days written - no 'ce Int~-event of cancellation. 10 C1avs no ice for non-ru!lV cancellation CERTIFICATE HOLDER CANCELLATION CITYASH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 E. Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland. OR 97520 AUTHORIZED REPRESENTA nvE ;;z.A.:! d/.f/ F. David Child, Jr. I . 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 Policy 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 subsequent to 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 performed 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 furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional 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 :, _Ins...., EndorumentNumbet JBR Environmental Consultants, Inc. PoUcySymboI ,__bot I PoIIcyPorlod Eltectlvll Date d Endotlemenl EPW G22062815 007 08/04/2010 TO 08/04/2011 _ Sy (Name of In....... Company) Westchester Surplus Lines Insurance Company Insert the policy twmber. The remainder of the InformaOon It to be- ccmpIaIed only when IhIs endofaemont II Issued MSGqU8nt to the peparaIIon of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ENDORSEMENT OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modlOes Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE CONTRACTOR'S POLLUTION LIABILITY COVERAGE SCHEDULE: NamA of pp.f'!Ilon or Oroanlzedon' 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. whereln such request Is made prtor 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 es en Insured the person or organization shown In the Schedule, but only with respect to lIeblllty arising out of your ongoing operations performed 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 epply to bodily Injury or property damage occurrtng after: (1) All work, Including matertels, perts or equipment furnished In connection with such work, on the project (other than service. melntenance or repaIrs) to be performed by or on behalf of the addIUonallnsured(s) etthe site of the covered operations has been completed; or (2) That portion of your work out 01 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 8 principal es 8 part of the same project. ENV-3100 (08-04) Includes copyrfghted meterlal of 'nsuranco Service. Offlco. Inc. with Ito permlnion Pagel ofl ~ Named Insured Endorsement Number JBR Environmental Consultants, Inc. Policy Symbol I Policy 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 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 Oroanin'lotion" Any person or organization that is an owner of real property or personal properly 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, infonnation required to complete this endorsement will be shown in the Declarations as applicabie 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.' ' AC:O~c:r 'leATE I III ITV ~. ""'.. - TliIS CERTIFICATE IS ISSUED M A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON TliE CERTIFICATE HOLDER. ~ II CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER TliE COVERAGE AFFORDED BY TliE POUCIES BEL jI TliIS CERTI~~TE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN TliE ISSUING INSURER(S~ AUTliORIZED REPRESENTAii Ii OR PRODUC AND TliE CERTIFICATE HOLDER. IMPORTANT: II the c:ertlflcale holder Is an ADDITIONAL INSURED, the pollcy{les) must be endorsed. If SUBROGATION IS WAIVED, sUbJeello iiO I8rms and condltlons of the policy, c:ertaln policies may require an endOlS8lTlenl A etatement on thla certlflcale doeo not confor rights 10 lit cartIflcats holder In lieu of aueIl endorsement(a). PROOUCER CONTACT NAME ATTENTION: GAIL BLOXHAM ~~~E2tt . I~f.!"". RJ AMMAN COMPANY .......L ADDRESS 7555 MARKET PLACE DR PROOUCER EDEN PRAIRIE MN 55344 CUSTOMER 10. . INSURER(S) AFFORDCNO COVERAGI HAlO . INSU!WI INSURER". w...... dOI1llUUrU1Ce Com'llAftY 1aJ33 JBRENVIRONMENTAL CONSULTANTS INC """""".. 8160 S mGHLAND DR SANDY, UT 84093 """"""'" """""".. """"""'" . ....... Po COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: TliIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERlO[ INDICATED. NOlWlTHSTANDING /lHX REQUIREMENT. TERM OR CONDITION OF />Nf CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TliIS 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. ..... ACOl. 6UllR POUCY EFl' POUCYEXP LlK 1YP& OF INSURANCE INSR .wyo POUCY WilBER (lI1lIIlIlI'NY't) (U1IIDll/'/YYY) ...ITS ~ENERAL LlAB'II.JTY EACH OCCURRENCP DAMAGE TO RENTED - 5~IAI.GEN"""LIAB~1TY PREMISEsr~OCCU'Tenl:>>\ . - ClAIMS MADE 0 OCCUR MED FXP IkN one - PERSONAL & IDV INJURY . -= GENERAl.AGGREGATE . l~~r9~FiL~ER PRODUCTS - COMPJOP AGO . POUCY JECT LOC AUTOMOBILe UABlUTY ~~SlNGlEUMrr . - """ AUTO OOY , - ALL OWNED AUTOS BOOLY INJURY(Pw~) . SCHEDUWl AUTOS =~DMWlE , - HIRED AUTOS -I - NON-Q'NNED AUTOS . , UMBRELlA UA8 H~ EACH OCCURRENCE! . EXCESSUA8 CLANSMADE AGGREGATE , ,... DEDUCTIBl.B , RETENTION I . WORKERS COMPENSAnON l.v'/COTAT\I-, I I'?J,\' AND I!IIPLOYE!R'S UABIUTY ~ TORYLlMrTS NlY PROPRIETORJPARTNERI l!XECUYM! A OFFICERlMEMBER . N1A 2163626 07/01/2010 07/01/2011 EXClUDED? EL EACH ACCIDENT 11,000.000 (IIMdatoryIn NH). EL DISEASE - EACH eUPLOYEE 11.OIXl.OCO Il'yes, dltaaIMI u'IdW -- DESCRIPllON OF OPEAATlOHS bIIIcw El DISEASE. POLICY LtMrr nooo.ooo DESCRIPTION OP OPERATIONS I LOCAllOHS I VEHJCLES CAtbtl:h ACORD 101,AddIOoRII Ranmb 8cMduk.1f1llDn ~ 1:1 NqUlred) Oregon CERTIFICATE HOLDER CANCELlATION CITY OF ASHLAND SHOULD AIf'f OF TliE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 E MAIN STREET TliE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN ASHLAND, OR 97~ZO ACCORDANCE WITH TliE POUCY PROVISIONS. ..' AU1HORlZEO {p4.'n -- r ~ ACORD 25 (2OOlWO) 01988-2009 ACORD CORPORATION, AD tfghta....rwd. The ACORD name and logo In ~rad m8fb of ACORD.