The URL can be used to link to this page

Home My WebLink AboutInsurance Certificate: Ashland Construction-S OR Concrete ~ ACORD"" CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIODlYYYY) \...,....---' 3/18/2011 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, EXTENO 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 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 endorsement,s). PRODUCER ~~:1~CT Paula Ortiz Beecher Carlson Insurance Agency LLC -r~.NJO..Ell:t). (541) 772-1111 . I r~ Nol; (541)772-3785 707 Murphy Rd i.DMDA~~ss: paula. ortiz@beechercarlson.com _~~~~~~~.ID_ ...00012132 Medford OR 97504 INSURERI5) AFFORDING COVERAGE NAle# INSURED INSURER A :Hallmark/TGA Ins Mars INSURER B :Assurance Co' of America 19305 Ashland Construction Inc, DBA: Southern INSURER C ; Oregon Concrete Pumping INSURER D ; 102 Pleasant View INSURER E ; Talent OR 97540 INSURER F ; COVERAGES CERTIFICATE NUMBER:2011 REVISION NUMBER: THIS lS 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. INSRI TYPE OF INSURANCE I~~~':-I~:I POLlCY NUMBER I POLlCY EFF I POLICY EXP I LIMITS LTR MMfDDfYYYY MM/DDlYYYY GENERAL LIABILITY EACH OCCURRENCE . 1,000,000 '--- DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence . 100,000 A I CLAIMS-MAOE [i] OCCUR X 4CL463822 3/21/2011 3/21/2012 MED EXP (Anyone person) . 5,000 . PERSONAL & AOV INJURY . 1,000.000 - - GENERAL AGGREGATE . 2,000,000 ~'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG . 2.000.000 X POLICY n ~~PT n LOC . AUTOMOBILE LIABILITY 1004681732 I I COMBINED SINGLE LIMIT . 1,000,000 fx (Eaaccidenl) '--- ANY AUTO BODILY INJURY (Per person) . B ALL OWNED AUTOS :3/21/2011 ,3/21/2012 '--- BODILY INJURY (Per accident) . '--- SCHEDULED AUTOS PROPERTY DAMAGE . '--- HIRED AUTOS (Per accident) NON-GWNED AUTOS PIP-Basic . 10,000 '--- UninsuredfUnderinsured . 1,000,000 UMBRELLA L1AB H IOCCUR EACH OCCURRENCE . - - EXCESS LIAS CLAIMS-MADE - - AGGREGATE . f- DEDUCTIBLE . RETENTION . . WORKERS COMPENSATION I T~~-7IfJN~ I 10J~- AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE D E.L. EACH ACCIDENT . OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) E.l. DISEASE - EA EMPLOYE . ~~~~~~ir~~ bn:~PERATIONS below E.l. DISEASE - POLICY LIMIT . I I I DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101. Additional Remarks Schedule, If more space is required) Certificate holder included as additional insured as respects general liability where required by written contract. This form is subject to policy terms, conditions, and exclusiona. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCOROANCE WITH THE POLICY PROVISIONS. Oregon Department of Transportation 20 E Main St AUTHORIZED REPRESENTATIVE Ashland, OR 97520 Mike Mastroni/PAUORT f~~ . ACORD 25 (2009/09) I NS025 (200909) @1988-2009ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ~ ACORD'" CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDIYYYY) ~ 3/18/2011 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 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 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 endorsementlsl. PRODUCER ~~=~~CT Paula Ortiz Beecher Carlson Insurance Agency LLC I f.&HJ>H,:' Ex": (541) 772-1111 I r~ Nol: (541)772-3785 707 Mu.rphy Rd ~~OA~~SS: paula. ortiz@beechercarlson.com PROOUCE~ 'flJlPOO12132 Medford OR 97504 INSURER(S) AFFORDING COVERAGE HAle # INSURED INSURER A :Hallmark/TGA Ins Mgrs INSURER B :Assurance Co of America 19305 Ashland Construction lnc, DBA: Southern INSURER C : Oregon Concrete Pumping INSURER 0 : 102 Pleasant View INSURER E : Talent OR 97540 INSURER F : THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATEO. NOTWITHSTANDING ANY REOUIREMENT, 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. INSR ADDL,SUSR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE II.Ic:.CO I wvn POLICY NUMBER MMIDDIYYYY MMIDDIYYYY GENERAL LIABILITY r--- X COMMERCIAL GENERAL L1ABILlTI I CLAIMS-MADE [iJ OCCUR COVERAGES CERTIFICATE NUMBER:2011 REVISION NUMBER; LIMITS A :.3/21/2011 3/21/2012 EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES {Ea occurrence $ MED EXP (Anyone person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ COMBINED SINGLE LIMIT $ (Eaaccident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) PIP.Basic $ Uninsured/Underinsured $ EACH OCCURRENCE $ AGGREGATE $ $ $ ~'ZC STAT~~ I 10J~- QRY_LJMlT E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ 4CL463822 r--- f-- ~'L AGGREGATE LIMIT APPLIES PER: I X I POLICY n ~WT n LOC AUTOMOBILE LIABILITY f-- ~ ANY AUTO B I-- ALL OWNED AUTOS r-- SCHEDULED AUTOS r-- HIRED AUTOS I-- NON-QWNED AUTOS I .3/21/2011 1004681732 I 13/21/2012 ~ UMBRELLA L1AB EXCESS LIAS HOCCUR CLAIMS-MADE I-- DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE D OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION 1,000,000 100,000 5,000 1,000,000 2,000,000 2,000,000 1,000,000 10,000 1,000,000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION OATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 20 E Main Street Ashland, OR 97520 AUTHORIZED REPRESENTATIVE Mike Mastroni/PAUORT f'~~ ACORD 25 (2009109) INS025 (200909) @1988.2009ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD