HomeMy WebLinkAboutInsurance Certificate: Cut n Break Construction (2) Acc>Rbp CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDMYYY)
`..i* 3/29/2011
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 pollcy(les) 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 NAME: Susan Wilson, AAI, AIC '
Beecher, Carlson Insurance Agency LLC PHCrNO EM. (541)772-1111 1 NC No:(541)772-3785
707 Murphy Rd ADDRESS:susan.wilson@beechercarl son.Con
rlcooucER 00020168
CUSTOMERIDS.
Medford OR 97504 INSURER(s)AFFORDING COVERAGE NAICf
INSURED INSURER A American Hallmark Ins Co of TX 43494
Cut N Break Conatruetion Inc; INSURER B:SAIP' 52412
John Lawton Builders INSURERC:Nestern Surety Company
P O BOX 1455 INSURERD:
INSURERE:
Medford OR 97501-0108 INSURERF:
COVERAGES CERTIFICATE NUMBER:CL1132 9 0 0119 REVISION NUMBER:
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 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF POLICY EFF POLICY EXP
LTR POLICY NUMBER MMI MMIDD LIMITS
ceNERAL uASarn EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY+A PREMISES Ea oav�ence E 100,000
A CLAIMSADE OCCUR' 4CL44930204 4/13/2011 9/13/2032 MED EXP(Any one person) $ 5,000
PERSONAL&ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GENLAGI REGATELM IT APPLIES PE R: PRODUCTS-COMP/OP AGG $ 2,000,000
X POLICY PRO LOC S
AUTOMOBILE LMBILnY COMBINED SINGLE LIMIT $ 1,000,000
X MY AUTO (Ea eccitlenq
A ALL OPNED AUTOS 4CL44930204 4/13/2011 4/13/2012 BODILY INJURY(Per person) $
BODILY INJURY(Per aceitlen) $
SCHEDULED AUTOS PROPERTY DAMAGE
HIRED AUTOS IPerecoceNl S
NON-oMEDAUTOS Metlioal payment S 5,000
Dm Boma $ 15,000
UMBRELLA UAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS{r1ADE AGGREGATE E
OFFX C;TIRI.F $
RETENTION $ $
B WORHERSCOMPENSAMON 8 NC STATU- I OTH-
AND EMPLOYERS'LIASILITY YfN TORY LIMITS ER
ANY PROFRIETOR,PARTNERI EGJNVE E L.EACH ACCIDENT $ 500,00
OFFI CEPnAer R EXCLUDEOP NIA
(Man4rtory in NH) 89003 10/1/2011 10/1/2012 E.L.DISEASE-EA EMPLOYEE $ 500,000
If yes,tlescibe under
DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT $ 500,000
C SOLI Bond-Prevailing Wage 0106243 6/5/2011 6/5/2012 Umd. $30,000
(SGetutory)
DESCRIPTION DF OPERATIONS/LOCATIONS I VEHICLES (Aaach ACORD 101,AAtlttbnel Remen.schowe,If more space Is required)
Certificate holder included as additional insured (excluding work comp) per attached endorsement 0@95380305 where
required by written contract. Subject to policy terms, conditions and exclusions.
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 ACCORDANCE WITH THE POLICY PROVISIONS.
Kari Olson
90 N Mountain Ave AUTHORIZED REPRESENTATIVE
Ashland, OR 97520
S Wilson, AAI, AIC/SU
ACORD 25(2009109) ®1988-2009 ACORD CORPORATION. All rights reserved.
INS025(200909) The ACORD name and logo are registered marks of ACORD