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Home My WebLink AboutInsurance Certificate: Brotherton Pipeline Inc ACORY CERTIFICATE OF LIABILITY INSURANCE OPID ME I DATE(MMlDOIYYYY) ~ OS/26/11 THIS CERTIFICATE IS ISSUEO 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 ISSUINGINSURER(SI, AUTHORIZED -. .. REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. ,_ . - _'_,>"" __ . . _ _.._. Im"v~.I"''''I:.,~fthe certificate holder IS, an . .' the POIICY(leS)..:rry~st~ ,endorsed. ',' _ _ . .,S~b~ectto .__.._ the terms and'condltlons of the policy, certain polldes'may require an endorsement A statement on this certlficate,does not confer rights to the., certlflcate'holder In:Ueu of such endorSemej,t(s).I~ .._ _ _ . _ __.. _ ___~. ._. ~. ~. .:..~./.' ~ ': -.,; ~_'. .: '_:~il_ _ .:':.. :_ __ . _:.,' _ _. ~ PRODUCER', . .....Jfl~.; l.,'I'-,. ~ .j ,. -' ;~';".rF. .'~.:C!.!..::' t ........;,~~-.; : Hart -Insurance .-- !P. O. Box 1240 Grants Pass OR 97528 Phone:541-479-5521 Fax:541-474-1890 NAME:, r~I\IJo Ext\: __ .n." "" .-u.."1 fAiC,N01: ADDRESS: CUSTOMER 10 II: 9BROTPI INSURER(S) AFfORDING COVERAGE Travelers Indemnity Co. INSURED INSURERA: INSURER B : INSURER C : INSURER 0 : INSURER E : INSURER F: SAIF CORP Brotherton Pipelinet Inc. Brotherton Corporat1on PO Box 738 Gold Hill OR 97525 Traveler. Property Ca.l,lalty Co COVERAG~S CERTlFICAiE NUMaER: REViSION NUMBER: THIS IS TO CERTIFY THAT THE POlCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED N.4.MED AEOVE FOR THE POLICY PERIOD INDICATED. NOTWTHSTANDING ANY REQUIREMENT. TERM OR CONDTION OF ANY CONTRPCT OR OTHER DOCUMENT 'MTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED CR MAY PERTAIN. THE INSURANCE AFFCRDED BY THE POlCIES DESCRIBED HEREIN IS SUBJECT TO All THE TERMS. EXClUSK:lNS AND CONDrnONS OF SUCH POlCIES.llMITS SHONN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I~~ TYPE OF INSURANCE INSR WVD POUCY NUMBER (MMlDDIYYYV) (MMlDDIYYY'f) GENERAL LIABILITY r- A X COMMERCIAL GENERAL LIABILITY I CLAIMS-MADE [!] OCCUR DTC052609764 EACH OCCLRRENCE PREMISES Ea oo::urrencel 06/10/11 06/10/12 1-:-;-, r- GEN'L AGGREGATE LIMIT APPLIES PER: .,.: R:POlICY!Xl j:gT n LOC AUTOMOBILE LlABIUTY .r-. c'" .. B X ANY AUTO' e=- ' -- .. ALL O\r'\oNED AUTOS. r- r- I------ HIRED AUTOS I------ NON..QWNED AUTOS X MED EXP (Anyone person) PERSONAL & ADV INJURY GENERAL AGGREGATE P.RODUCTS - COMP/OP AGG !7r ......." .0." COMBINED SINGLE LIMIT (Eaaccident) , _ :.',. BODILY INJURY (Per person) BODILY INJURY (Per acadent) PROPERTY DAMAGE (P8f8ccioent) ., ) {.,::.:, ; I'.' -0 " .__\ o6"/loh"1 0~!loji2 " " . O"T8'10526D9764 . ~ . " . ...., ,.. SCHEDULEDAUTOS B ~ UMBRELLA LIAS EXCESS UAB ~ OCCUR I I CLAIMS-MADE EACH OCCLRRENCE AGGREGATE DTSMCUP52609764 06/10/11 06/10/12 DEDUCTIBLE X RETENTION $ 10000 C WORKERS COMPENSATION AND EMPLOYERS' UABILITY Y I ~l ANY PROPR1ETORIPARlNERlEXECUTI\fD DFFICERlMEMBffi EXCLUDED? I A (Mandatory In NH) ~~st~~fro~ O~OPERATIONS below 10/01/10 10/01/11 X ITORy LIMITS I IU~~- 810614 DESCRlPlION OF OPERAlIONS I LOCAlIONS / VEHICLES (Attach ACORD 101, Additional Remark.Schedule, If more .pace I. required) Certificate Holder is named as Additional Insured. CERTIFICATE HOLDER CANCELLATION ." NAlC# 10647 10647 UMITS $1,000,000 , 300,000 '10,000 ,1,000,000 ,2,000,000 .'.2,000.,000 , ',1,000,0.00 , -.. .. , , , , '2,000,000 '2,000,000 , , SHOULD ~y OF THE ABOVE DESCRIBED POUCIES BE CANCEUED BEFCRE SINGSH1 THE EXPIRAlION DATE THEREOF, NonCE NLL BE DB.NERED IN ACCORDANCE WITH THE POUCY PROVISlOOS. .~ @ 1988-2009 ACORD CORPORATION. /lJ ghts ",.erved. The ACORD name and logo are registered marks of ACORD CITY RECORDER Ci ty of Ashland Purchasing Representative 90 N. MOuntain Avenue h1and OR 97520 AUTHORIZED REPRESENTATIVE Mich ACORD 25 (2009/09) ~ , - "-" COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART "-' - = - -= ..E:;;;! -= -= = -== """" 0==: iiiii - ..e;;;; == .- ,- ~ - \".r 002700 1. WHO IS AN INSURED - (Section II) is amended to include any person or organization that you agree in a "written contract requiring insurance" to include as an additional insured on this Cover- age Part. but: aj Only with .respect to liability for "bodily injury", "property damage" or "personal injury"; and b) If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies. The person or organization does not qualify as an additionai insured with respect to the independent acts or omissions of such person or organization. 2. The insurance provided to the additiona/lnsured by this endorsement is limned as follows: aj In the event that the Limits of Insurance of this Coverage Part shown in the Declarations exceed the limits of liability required by Ihe "written contract requiring insurance", the in- surance provided to the addnional insured shall be limited to the limits of liabilny re- quired by that "written contract requirtng In- suranee". This endorsement shall not in- crease the limits of insuranee described In Section 111- Limits Of Insurance. b) The insurance provided to the additional in- sured does not apply 10 "bodily injury", "prop- erty damage" or "personal injury" ariSing out of the rendering of, or failure to render, any professional architectural, engineering or sur- veying services, Including: i. The preparing, approving, or failing to prepare or approve, maps, shop draw- ings, opinions, reports, surveys, field or- ders or change orders, or the preparing, approving, or lailing to prepare or ap- prove, drawings and specifications; and ii. Supervisory, inspection, architectural or engineering activities. c) The insurance provided to the additional in- sured does not apply to "bodily injury" or "property damage" caused by "your work" and included In the "products-completed op- erations hazard" unless the "written contract requiring "insurance" specifically requires you to provide such coverage for that addnional insured, and then the insuranee provided to the additional insured applies only to such "bodily injury" or "property damage" that oc- curs before the end of the period of time for which the "written contract requiring insur- anee" requires you to provide such coverage or the end of the policy period, whichever Is eartier. 3. The insurance provided to the additional insured by this endorsement is excess over any valid and collectible "other insurance", whether primary, excess, contingent or on any other basis, Ihat is available to the additional insured for a loss we cover under this endorsement. However, if the "written contract requiring insurance" specifically requires Ihat this Insurance apply on a primary basis or a primary and non-contributory basis, this insurance is primary to "other insurance" available to the additional insured which covers that person or organization as a named insured for such loss, and we will not share with that ,"other insurance". But the insurance provided to the additional insured by this endorsement stili Is .excess over any valid and collectible "other in- surance", whether. primary; excess, contingent OJ on any other basis, that is available to the addJ.;. tional insured when that person or organization is an additional insured under suctl "other insur- ance-, 4. As a condition of coverage provided to the additional insured by this endorsement: a} The additional insured must give us written notice as soon as practicable of an "occur- rence" or an offense which may result in a claim. To the extent possible, such notice should include: CO 02 46 08 05 @2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 -. . . COMMERCIAL GENERAL LIABILITY i. How, when and where the "occurrence" or offense took place; ii. The names and addresses of any injured persons and witnesses; and iii. The nature and location of any injury or damage arising out of the 'occurrence" or offense. b) If a claim is made or "suit" is brought against the additional insured, the add~ional insured must: i. Immediately record the specifics of the claim or "suit" and the date received; and ii. Notify us as soon as practicable. The edd~ional insured must see to it that we reCeive written notice of the claim or "suit" as soon as practicable. c) The add~ional insured must Immediately send us copies of all legal papers received In connection with the claim or 'suit", cooperate with us in the investigation or settlement of the claim or defense against the "su~", and otherwise comply with all policy conditions. d) The additional insured must tender the de- fense and indemnlly of any claim or "suit" to any provider of "other insurance" wtlich would cover the additional insured for a loss we cover under this endorsement. However, this condition does not affect whether the insur- ance provided to the additional insured by this endorsement is primary to "other insur- ance" ava~able to the add~lonal insured wtlich covers that person or organization as a named insured as described in paragraph 3. above. 5. lihe following definition is added to SECTION V. -' DEFINITIONS: "Written contract requiring insurance" means that part of any written contract or agreement under wtlich you are required to include a person or organization -as an a_dditiona! in- sured on this Coverage Part, provided that. the "bodily injury" and 'property damage' 0c- curs and the 'personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Page 2 of 2 @2005 The St. Paul Travelers Companies, Inc. CG 02 46 08 05 .J .' .~ ..." ....J