The URL can be used to link to this page

Home My WebLink AboutInsurance Certificate: Construction Engineering THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFLILLY. E4277 Policy Number: 03499-60-76 1st Edition POLICY CHANGES Effective Date of Change: 07/15/11 Expiration Date: 05/10/12 Change Endorsement No.: 002 Agent: 73-01-341 - Named Insured: CONSTRUCTION ENGINEERING PO BOX 1724 MEDFORD OR 97501-0134 The following item(s): Insured's Name Insured's Mailing Address Policy Number Company Effective/ Expiration Date Insured's Legal Status/ Business of Insured Payment Plan Premium Determination X Additional Interested Parties Coverage Forms and Endorsements Limits/Exposures Deductibles Covered Property/ Location Description Classification/Class Codes Rates Underlying Insurance is (are) changed to read{See Additional Page(s)): The above amendments result in a change in the premium as follows: X No Changes To Be Adjusted At Audit Additional Premium Return Premium $ $ Authorized Representative Signature: FARM E RS 91 4277 1STIOMON 7-02 Induda(WIOMed lklorfnl,Imuronn Senim Ol0®,Inc,ndlh h pernWon. 14277101 PAGE I OF 2 14277{O1 Policy Changes Endorsement Description ADD ADDITIONAL INTEREST ADDITIONAL INSURED-CA20480299 ADDITIONAL INSURED-DESIGNATED INSURED CITY OF ASHLAND PUBLIC WORKS DEPARTMENT 20 E MAIN ST ASHLAND,OR 97520 2001 CHEVROLET SILVERADO VIN: 2GCEK19T211332787 2004 CHEVROLET SILVERADO Removal If Covered Property is removed to a new location that is described on this Policy Change, Permit you may extend this insurance to include that Covered Property at each location during the removal. Coverage at each location will apply in the proportion that the value at each location bears to the value of all Covered Property being removed. This permit applies up to 10 days after the effective date of this Policy Change: after that, this insurance does not apply at the previous location. 911277 1ST EDIIIOX 1-02 Indudss(Wighbd Almrtinl,1m an®Smlm OD1u, Inc,with Is perdsdm. E0271102 PAGE 1 OF 1 14271{01 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ R CAREFULLY. E4277 Policy Number: 03499-60-76 lsl E&HOU POLICY CHANGES Effective Date of Change: 07/15/11 Expiration Date: 05/10/12 Change Endorsement No.: 002 Agent: 73-01-341 Named Insured: CONSTRUCTION ENGINEERING PO BOX 1724 MEDFORD OR 97501-0134 The following item(s): Insured's Name Insured's Mailing Address Policy Number Company Effective/Expiration Date Insured's Legal Status/ Business of Insured Payment Plan Premium Determination X Additional Interested Parties Coverage Forms and Endorsements Limits/Exposures Deductibles Covered Property/Location Description Classification/Class Codes Rates Underlying Insurance is (are) changed to read{See Additional Page(s)}: The above amendments result in a change in the premium as follows: No Changes To Be Adjusted At Audit Additional Premium Return Premium $ $ Authorized Representative Signature: FARM E R5 914177 1STEDIDON 702 Iduda(RlEMod WarPol Iwrma Smfm ONl®,Im,wfih Is prdsdm. E4277101 PAGE I OF 2 11277{DI Policy Changes Endorsement Description VIN:2GCEK19VG41264550 2006 CHEVROLET SILVERADO VIN: 1 GCHK23U56F146536 Removal If Covered Property is removed to a new location that is described on this Policy Change, Permit you may extend this insurance to include that Covered Property at each location during the removal. Coverage at each location will apply in the proportion that the value at each location bears to the value of all Covered Property being removed. This permit applies up to 10 days after the effective date of this Policy Change: after that, this insurance does not apply at the previous location. 914777 ISS EOIFON 7-02 I Buda(cW1gMsd Molnlol,Imam Samlm Office, Inc,dih Is punisdm. E4277102 PAGE 2 OF 1 E4277401 BUSINESS AUTO DECLARATIONS FARMERS INSURANCE EXCHANGE ❑POLICY MEMBERS OF FARMERS INSURANCE GROUP OF COMPANIES ❑COVERAGE PART HOME OFFICE:4680 WILSHIRE BLVD,LOS ANGELES,CALIFORNIA 90010 ITEM ONE NAMED CONSTRUCTION ENGINEERING INSURED « um er o . oar� l MAILING PO BOX 1724 73-01-341 03499-60-76 ADDRESS gent olry umFT� er MEDFORD OR 97501-0134 Type of The named insured is an individual ❑Partnership ❑X Corp. Business ENGINEER unless otherwise stated: ❑Joint Venture ❑ Organization (Other than Partnership or joint venture) Policy Period from 07/15/11 (not prior to time applied for) to 05/10/12 12:01 AM Standard Time If this policy replaces other coverages that end at noon standard time on the same day this policy begins, this policy will not take effect until the other coverage ends. This policy will continue for successive policy periods as follows: If we elect to continue this insurance, we will renew this policy if you pay the required renewal premium for each successive policy period subject to our premiums, rules and forms then in effect. ITEM TWO SCHEDULE OF COVERAGES AND COVERED AUTOS *This policy provides only those coverages where a charge is shown in the premium column below. Each of these coverages will apply only to those "autos" shown as covered "autos'. "Autos" are shown as covered "autos for a particular coverage by the entry of one or more of the symbols from the COVERED AUTO Section of the Business Auto Coverage Form next to the name of the coverage. *COVERED AUTOS LIMIT THE MOST WE WILL PAY FOR COVERAGES ANY ONE ACCIDENT OR LOSS PREMIUM (LIMITS SHOWN IN THOUSANDS LIABILITY 7 9 S Soo 1 ,154.00 PERSONAL INJURY PROTECTION 7 SEPARATELY STATED IN EACH PIP ENDORSEMENT 192.00 (or uivalent No-Fau6 Coverage) ADDED PERSONAL INJURY PROTECTION SEPARATELY STATED IN EACH ADDED PIP ENDORSEMENT (or equivalent added no-fault cov.) PROPERTY PROTECTION INSURANCE SEPARATELY STATED IN THE P.P.I.ENDORSEMENT MINUS (Michigan only) S DEDUCTIBLE FOR EACH ACCIDENT AUTO MEDICAL PAYMENTS S SEE SCHEDULE UNINSURED MOTORIST 7 S SEE SCHEDULE 201 .00 UNINSURED MOTORIST 7 S SEE ENDOR INCLUDED PROPERTY DAMAGE UNDERINSURED MOTORISTS(When not S incl.in Uninsured Motorists Coverage) Actual Cash Value or Cost of Repair,whichever is PHYSICAL DAMAGE h ss minus S SEE SCHEDULE Ded.for hilt ch Covered COMPREHENSIVE COVERAGE 7 Auto.But no Deductible APpTjes tq Lost Caused�y Fire or 344.00 Li htnin .See Item Four ffi hhired or horrowed'autoi. PHYSICAL DAMAGE SPECIFIED to Cash V u o st o eau, is ev r iS CAUSES OF LOSS COVERAGE ess qus 2 l� Eqc Lover Auta or�Tr used vi I 'Auiefyr ands ism.See Item ur for hired or orro Autos . PHYSICAL DAMAGE Actual Cash Value or Cost of Rgair whichever is COLLISION COVERAGE 7 less minus S SEE SCHEDULE De ,for Each Covered 565.00 Auto. See item four for hired or borrowed Autos'. PHYSICAL DAMAGF-TOWING AND LABOR 7 S soo •autoo! (ACTUAL LIMIT)coven 66.00 PREMIUM FOR ENDORSEMENTS ESTIMATED TOTAL P E U 2,522.00 FARMERS 56-5190 61H EDI110N 3-10 (5190601 PAGE 1 OF 3 565190ED6 03499-60-76 Policy Number BUSINESS AUTO DECLARATIONS(Confiooed) REM THREE SCHEDULE OF COVERED AUTOS YOU OWN DESCRIPTION TERRITORY PURCHASED Y�pr,MMo�del Neace a ,B.pdy Typ F28720 Town&State where Covered Autort� Seri alllumber(51YetiJjgeMrticationlumber Ad�Bal�)IT, Auto will be principally garaged 0 YN 0 S MEDFORD 2GCEK19T211332787 2 04 CHEVROLET SILVERADO MEDFORD OR 4 2GCEygKg199LVVgTT641264550 3 06CFIGTECVHK23U56F146536 SILVERADO MEDFORD OR 4 CLASSIFICATION a lus a usmess use lice Age rim on ary a Except for touring all physical damage Operation s-service OR or VVeh. Group acing acing loss is payable to you and the loss r-retail Seating odor Factor payee named below as interests Cove c-commercial Capacity is m may appear al the time of the loss. 2 50 S 10000 8 1 .0000 1 .0000 01199 3 50 S 10000 6 1 .0000 1 .0000 01199 Bence at a de uctl a or Fmd entry In any column below means that the limit or deductible entry In the corres on in ITEM Tyfb co umn a lies instead LIABILITY PERSONAL INJURY PROTECTION ADDED P.LeeP.. gut PROP.PROT. Mich.only)(�, � * Imd Premium II so minu�de remlum ppImA�T011 ijnd.c end mnus ud.. remlum AutorNo. Ping 11�e shoMerw Premium shown helow 1 500 U 64 on 2 500 349.00 0 64.00 3 500 349.00 0 64.00 ota Premium 1 ,047.001 001 L a ul a eBence o a deductible or lima entry In any column below m r ry in Re corres ondin a ITEM TYCO column applies instead) AUTO MED. Covered PROPERTY DAMAGE Auto No. Fmd Premium * Imd Premium *Limit Premium *Lima Premium 2 Soo 67.0 500 INCLUDED 3 500 67.0 500 INCLUDED ata Premium 201 .0( Bence o a uctl or Imd entry Fn any co umn a ow means t at t e Imd or octl a entry In t e corres ondin ITEM*b column applies instead star Premium Limit st In rt stet Fq Premium Imd Per Premium Covered Feinus r�e uc- U �nlnus �U"t. DisaD�ement Coto o. ti Ie s own a ow Premium s own e w T-- Soo 171 00 2200 2 500 116.00 500 189.00 500 22.00 3 500 122.00 500 205.00 500 22.00 ota Premium 344.00 565.00 66.00 *(LIMITS SHOWN IN THOUSANDS) 56-5190 6TH EDITION 3-10 C5190602 PAGE 2 OF 3 56519MD6 03499-60-76 ' BUSINESS AUTO DECLARATIONS(CONTINUED) Policy Number ITEM FOUR SCHEDULE OF HIRED OR BORROWED COVERED AUTO COVERAGE AND PREMIUMS LIABILITY COVERAGE ATI BASIS,COST OF HIRE ( STATE ESTFHYOIARTE�D�CIOST OF HIRE COST PER EACH 100 CFOAV K PRUINRY) PREMIUM PREMIUM Cost of hire means the total amount you incur for the hire of"autos" you don't own (not including "autos" you borrow or rent from your employees or their family members). Cost of hire does not include charges for services performed by motor carriers of property or passengers. PHYSICAL DAMAGE COVERAGE LIMIT OF INSURANCE ESTIMATED RATES PER PREMIUM COVERAGES THE MOST WE WILL PAY ANNUAL EACH$100 DEDUCTIBLE COST OF HIRE COST OF HIRE VALUE LU51 OF REPAIK5 OR COMPREHENSIVE S WHICHEVER IS LESS MINUS $ DED.FOR EACH COVERED AUTO. BUT NO DEDUCTIBLE APPLIES TO LOSS CAUSED BY FIRE OR LIGHTNING. ACTUAL LASH VALUE,COST Of REPAIRS OR SPECIFIED S WHICHEVER IS LESS MINUS CAUSES OF LOSS S25 DED.FOR EACH COVERED AUTO FOR LOSS CAUSED BY MISCHIEF OR VANDALISM. ACTUAL L45H VALUE,COST OF REPAIRS OR COLLISION S WHICHEVER IS LESS MINUS S DED.FOR EACH COVERED AUTO PREMIUM ITEM FIVE SCHEDULE FOR NON-OWNERSHIP LIABILITY NAMED INSURED'S BUSINESS RATING BASE NUMBER PREMIUM Ot er t an a Num er o Em o em 4 107.00 Social Service en Num er o Partners SociaTService Agency Number of m o ees Number ot Volunteers IN RETURN FOR THE PAYMENT OF THE PREMIUM,AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. Premium shown is payable: $ 2,522.00 at inception. ENDORSEMENTS ATTACHED TO THIS POLICY: IL 00 21-Broad form Nuclear Exclusion (Not applicable in New York) CA00010310 CA00100310 CA00381202 CA20480299 CA21050110 CA21870110 CA22360110 ILOOZ10499 iL0Z19UYUZ J6738-ED1 57338-ED1 LOSS PAYEE COUNTERSIGNED BY Date Aut on Representative 565190 6TH EDITION 310 (5190603 PAGE 3 OF 3 56519ND6 POLICY NUMBER: 03499-60-76 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provision of the Coverage Form. This a ndorsement does not after coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: Countersigned By: 07/15/11 Named Insured: CONSTRUCTION ENGINEERING Authorized Representative) SCHEDULE Name of Person(s)or Organization(s): CITY OF ASHLAND (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is 'An Insured Provision contained in Section 11 of the Coverage Form. CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1