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Home My WebLink AboutInsurance Certificate: Cut N Break Construction . .-----.. ACORD. CERTIFICA TE OF LIABILITY INSURANCE I DATE (MMIDDNYYY) ~. 3/29/201.1. 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 I. an ADDIT10NAL INSURED, the pollcy(le.) 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 certlflcate holder In lieu of such endorsementlst . PRODUCER NAMEt'-' I Susan Wilson, AAI ,AIC Beecher carlson 7nsurance Aqency LLC Wg~o E"'" (541) 772-1111 I &O~.Nol: (541)172-3795 707 Muzphy Rd ~~~ss:susan.wi15on@beechercarlson.com ~ng~~~ID,pOO2016B Medford OR 97504 INSURER(S) AFFORDING COVERAGE HAle' INSURED I~URERA~rican Hallmark Ins Co of TX 3494 INSURER B :SAII" 2412 cut N Break construction J:nc INSURER C :Wes tern Surety Caapany PO Box 1455 INSURER 0 : 1N$UR&R.1i : Medford OR 97501-0108 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 INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT Wm-l RESPECT TO W-tICH TI-lIS 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~.w: lYPE OF INSURANCE ~~i= POLICY Nl.NBER :~MW~ =~~ GeNeRAL LlA6lLrTY - . X COVERAGES CERTIFICATE NUMBER:CL113290D119 REVISION NUMBER: UMlTS A COMMERCLAJ. GENERAL lIABILITY I ~LAIMs.MADE 00 OCCCR .. EACH OCCURRENCE PREMISES iE~~~;'~mce MED EXP (Anyone person) /13/2011 /13/2012 4CL44930204 r- r- ~<lAGGRE~E,L1MIT AP~SPER IXlpOLlC'l'1 IPfRT I IlOC AUTOMOBIl.E LIABILITY I=- ~1>N'l'AlJTO A f-- All O'fo.NED AUTOS f- SCHEDULED AUTOS f-- HiRED AUTOS f-- NON-OVINEDAUTOS PERSONI\L $. /'DV IN,).IRY GENERAL. AGGREGATE $ PRODUCTS. COMP/OP AGG $ $ /13/2011 /13/2012 COMBINED SINGLE LIMIT (Ea accident) BODilY INJURY (Per person) $ $ ~4CL44930204 BODll'l' INJURY (Per a<<idert) PROPERTY DAMAGE (Peraccidert) MedioolP8)lTlents [">1r>9o:lOo UMBRELLA LIAB U OCCUR [ I CLAIMs.MADE " EACH OCCURRENCE AGGREGATE r- EXCESS UAB ~ _ OFf"'llIr.1IHIF RETENTION I B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORIPARTNER!EXEQJTlVE D OFFICERJMEM8EP ~CLUDED? N I A (Mandatory In NHI If yes, desaibe under DESCRIPTION OF OPERATIONS below C BOLl Bond-Prevailing Wage (Statutory) DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AttBchACORD 101, Additional ~markl Schldule, If more space II required) Certificate ho1der included as additional insured (excluding work comp) per attached required by written contract, Subject to pol.icy terms, conditions and exclusions. I ,.~JT~;,~~ ! IO:~. E.l. EACH ACCIDENT $ E.l. DISEASE. EA EMPLO'l'E $ E.l. DISEASE - POLICY LIMIT $ lim~ 89003 0/1/2010 p..0/1/2011 0106243 /5/2010 ~/5/2011 $ $ $ l,OOO,OOO 100,000 5,000 1,000,000 2,000,000 2,000,000 1,000,000 $ $ . $ $ $ $ 5,000 15,000 500 000 500 000 500 000 $30,000 endorsement MP9538030S where CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF ntE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRA TlON DATE THEREOF, NOnCE WILL BE DELIVERED IN city of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. Kari Olson 90 N MOuntain Ave AUTHORIZeD RePReSeNTATIVE! Ashland, OR 9752D S Wilson, MI, AIC/SU~ ~./.{.,-~ ACORD 25 (2009/08) INS025 (200909) @ 1889-2009 ACORD CORPORATION. All rights re.erved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET'ADDITIONAL INSURED ENDORSEMENT This endorsement modifies the insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM A. SECTION II - WHO IS AN INSURED is amended to include as an insured any person or organization (referred to below as Additional Insured) whom you alt' ''''lui,,,d Lu add as an additional Insured on this policy under: 1. A written contract or agreement; and 2. Where a certificate of Insurance showing that person or organization as an addrtional insured has been issued; and 3. When the written contract or agreement and the certificate of insurance are currently in effect or becoming in effect during the term of the policy and executed prior to the "bodily injury," "lJrup~lly damage" or "personal and advertising injury." B. The insurance provided to the Additionallnsured(s) is limited as follows: 1. The Additionallllsuled(~) i~ ullly all addiliullal insured for: a. "Bodily injury," "property damage" or "personal and advertising injury" caused In whole or in part by negligent acts or omissions of the Named Insured or anyone directly or indirectly employed by the Named Insured or for whose acts B Named Insured may be liable. b. Liability arising out of your ongoing operations for the Additional Insured(s) by or for you. A person's or organization's status as an insured under this endorsement ends when your npF!r~1ions for that insured are completed. 2. The Limits of Insurance applicable to the Additional Insured(s) are those specified in the written contract or agreement but not more than the Limits of Insurance specified in the Declarations of this policy. The Limits of Insurance applicable to the Additionallnsured(s) are inclusive of and not in addition to the Limits of Insurance shown in the Declarations for the Named Insured. C. In addrtiDn to the other exclusions applicable to Coverages A, B, and C, the insurance provided to the Addilionallnsured(s) does not apply to: 1. "Property damage" to: a. Property owned, used, occupied by, loaned or rented to the AdditiDnallnsured(s); b. Property in the care, custOdy or control of the Additionallnsurad(s) or over which the Additional Insured(s) are for any purpose exercising physical control; or c. "Your work" performed for the Addilionallnsured(s). 2. "Bodily injury," "property damago" or "personal and odvertising injury" arising out of 8n architect's, engineer's or surveYD(s rendering or failure to render any professional services for you, for the AdditiDnallnsured(s) or for others, including, but not limited to: a. The prepAring. Approving or failure to prepare or approve maps, drawings, opinions, reports, surveys, change orders, designs or specifications; or b. Supervisory, inspection or engineering services. 3. "Bodily injury" or "proparty damage" occurring aftar: a. 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 srte of the covered operations has hAen 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 subcontractor engaged in performing operations for.a principal as a part of the same project. MP 95 38 03 05 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of1