HomeMy WebLinkAboutInsurance Certificate: Adroit Development
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ACORD" CERTlFICA TE OF LIABILITY INSURANCE I DATE (MMIODIYYYY)
~. 6/30/20J.J.
THIS CERllFICATE IS ISSUED AS A MATTER OF INFORMAllON ONLY AND CONFERS NO RIGHTS UPON THE CERllFICATE HOLDER, THIS
CERTIFICATE DOES NOT AFFIRMAllVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERllFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BElWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERllFICATE HOLDER.
IMPORTANT: If the corllflc.to holdor Is an ADDIllONAL INSURED, tho pollcy(los) must bo ondorsod, If SUBROGAllON IS WAIVED, subJoct 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 endorsemenUst
PRODUCER ~~E~l,O' Susan Wilson, AAI, AlC
Beecher carlson Insurance Aqency LLC I rA~g':io ..,,, (541) 772-nn I OO~. Nol: (541) 772-3785
707 Mu:<phy Rd ~~~~ss:susan.wilson@beechercarlson.com
~~~~~ID,POOO9589
Medford OR 975D4 INSURER(SI AFFORDING COVERAGE NAIC..
INSURED INSURER A :American safe tv Insurance Co
INSURER B ;SAJ:1!" 24J.2
Adroit Development Co Ine INSURER C :Wes tern Surety Caapany
PO Box 936 INSURER 0 :
lNSUR6R& :
Ashland OR 97520 INSURER F :
COVERAGES
CERllFICATE NUMBER:CLn63003869
REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 8ELOOI 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 \MilCH TI-iIS
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 = LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I~f:: TYPE OF INSURANCE IN POLlCY NUIlBER :~;~~ II~~PCY EXP UMlTS
liI:NI:RAL.l..lAelL.ITY EACH OCCURRENCE $ 1.,000,000
-
X COMMERCIAL. GENERtIL LLPJ3IL1TY PREMISES Ea occurrence' $ 50,000
A I CLAIMS-MPDE 00 OCCUR SL0141561105 1I/20ll /1/2012 MED EXP (My one person) $ EXCLUDED
PERSON/\L & /lDV IN.)JRY , 1,000,000
GENERAL AGGREGATE I 2,000,000
-il~ AGG~EnE LIMIT API~EtIPER PRODUCTS - COMPIOP AGG $ 2,000,000
X POLICY Pf,Qr LOC PollulionLiabillty I 100,000
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
- (Eaeccidentl
- ANY AUTO BODILY INJURY (Per person) $
- tilL O'o'.f\lED )l.JJTOS BODILY INJURY (Per accident) I
- SCHEDULED AUTOS PROPERTY Q.4MAGE
$
HIRED AUTOS (Paracddent)
- $
NON-O'<\NED )l.JJTOS
- .
UMBRELLA LIAS H OCCUR EACH OCCURRENCE I
-
EXCESS LIAS ClAlMs-MADE AGGREGATE I
- OFI1lICTIRI F I
RETENTION . I
B WORKERS COMPENSATlON IN:, ST ATU- IO~,\'
AND EMPLOYERS' LIA.Sl1.llY V'N
ANY PROPRIETORiPARTNERJEXEOJTIVE 0 N/A EL EACH ACCIDENT I 500 000
OJ::J::ICERIMEMBER EXCLUDED? 0/1/2010 0/1/201.1
(Mandatory in NH) 66512 E.l. DISEASE - EA EMPLOYEE I 500 000
If yes, dasaibeunder EL DISEASE - POLICY LIMIT I 500 000
DESCRIPTION OF OPERATIONS below
C BOLl Bond 8637467 0/31/2010 0/31/2011 Lim~ $30,000
Statutory
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remark. Sc:h.dule, If mora .pac:e I. requlrad)
Re: Snowberry Brook project, 350 Clay St, Ashland, OR 97520. Certificate holder included as additional insured
(excluding work comp) per attached endorsement ES981221005 where required by written contract. Subject to policy
term", eonditiono ~nd QZc~uoiono.
CERllFICATE HOLDER
CANCELLAll0N
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Ci ty of Ashland ACCORDANCE WITH THE POLICY PROVISIONS.
20 I!:ast Main
Ashland, OR 97520 AVTHCIRlZEO Ref"ReSENTATTVE
S Wilson, AAJ.., AIC/SU S'.f Il... ~. vt.-~_
ACORD 25 (2008/08)
INS025 (200909)
@198B-20D9ACORDCORPORAllON. All right. ro.orvod,
The ACORD name and logo are registered marks of ACORD
.~
,.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ASIC - ES 98 15 05 08
ADDITIONAL INSURED ENDORSEMENT -- OWNERS, LESSEES OR CONTRACTORS
(MODIFIED FORM B)
This Endorsement shall not serve to increase our limits of insurance, as described in SECTION III -
LIMITS OF INSURANCE,
Name of Person or Organization: Project owners or general contractors, if other than a named insured, as well
as their directors, officers and employees where required to be named as an
Additional Insured in a written contract with the Named Insured entered into
fJliul tu the Iu~~ UI Ul,;l,;Ullerlll~.
Effective Date: The later of the effective date of this policy or the date on which "your work"
first started on the applicable project for which this Endorsement applies, but in
no event later than the policy expiration date or applicable earlier termination
date of this policy.
In conSideration at the payment at premiums, It IS hereby agreed that the tollowlng changes are Incorporated Into the
policy:
WHO IS AN INSURED (SECTION II) IS amended to Include as an Insured the person or organization shown above, but
only with respect to defense and liability arising out of ''your work" This endorsement applies only to ongoing operations
performed by the Named Insured for the Additional insured on or after the effective date of this Endorsement.
Coverage under this Endorsement applies only as respects a legally enforceable written contract with the Named Insured
and only for defense and liability arising out of or relating to the Named Insured's sole negligence and only for "bodily
injury" or "property damage" caused by an "occurrence" under Coverage A not otherwise excluded in the policy to which
this Endorsement applies.
If this policy includes a self-insured retention or deductible endorsement, such endorsement shall apply and affect our
obligations pursuant to the policy.
It is further understood and agreed that irrespective of the number of entities named as insureds under this policy in no
event shall the Company's limits of liability exceed the limits of liability designated in the Deolarations.
All other terms, conditions and exclusions under the policy are applicable to this Endorsement and remain unchanged.
ES 9815 05 08
Copyright@ 2008 American Safety Indemnity Company
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