HomeMy WebLinkAboutInsurance Certificate: Evergreen Job & Safety 02/10/2012 17:21 FAX 2022634001 HAYS OF DC IA001/001
OP ID: 08
CERTIFICATE OF LIABILITY INSURANCE °"oy o 12'
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATF. 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(SI, AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER
IMPORTANT: It the certificate boldul is an ADDITIONAL INSURED.the poliey(iee)must be endorsed. H SUBROGATION IS WAIVED, subject to
the farms and conditions of the policy.certain policies may require an endorsement A Rtoterrio tt an this corrlf eato does not condor rights to the
cortiREalo holder In Ilou of ouch ondoraemant s.
FROa110ER 202-2634DOO C'�WAC
Hays Affinity Solutions
202-2634001 , L0 ^!! _
7133 20th St.N,W.,Suite 450 P'
Washington,DC 20036 "six ocEp--' -- – ---
Barry F.Peters Mmmr EVERG•2 _. . .... ..--
wEUnER(SJKFORPIea COVERAGE ___J_ _ —_NPICe_
waueFO Evergreen Job&Safety wBLMER A:Lloyds of London
Training wswcR n
Douglas Lindstrom .___...._.._..______—_ .. ..........__._,. .
309 KnOCh Avenue wsunrRC.
Susanville,CA 96130 MBR O
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r _m:R_e_
IRER F,
COVERAGES CERTIFICATE NUMBER' REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSIIEO TO THE INSURED NAMED AOOVE POR Tlir POLICY PERIOD
INDICATED. NOTWITHSTANDNG ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CC11TIrcATC MAY DC ISSUED Oft MAY CERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM:.
EXCLUSI(7N;:AND CON01TIONS Of SI)Cs P(XICIES.LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAMS.
IT rvPF.MNIIIMANEF raUCy eUaDFR M:san'\' MMAOP'YYY LBLIR
GENERAL 140A11Y
_. 2.000.00
.:/MLYUA:W_riI:WFIL LI^GL.A\' : ;FC'Y4�^I:P^'"Wf� 1DD.DD
1 _ X nALM.;awa• u•xFlw iEK.^tAmo\-owrarn i1 2,00
A X General Liability I 1202111IFA000080 0305112 1 02/05113 IP."F:Ylat a:�'\r n.r_'r'' _r{ 2,000,00
I C"EPM PSgAFCATP I V 4,000,00
I:r.1rt/0s 1,1(}\a'CCATE IL m bnT.
AW.-PCP.
X . 2.00.00
•Ur LIMOBILE WBIIIry j C.IIMF:N"OwL:bl r•IN!I r
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wok"LIMCOM11CMUAIKN I \k ✓,1::. Ip
AND EMPlOYERE'Lln&uTY YrN
H-Y!M'.MW.4 Y.]ZN/W IAlhP1i'!1P.IN
CRrpVOR'sEelna✓_xtt1.:uCM i N/A _ .... ..._. ........_.. .—.__
(MLMMarrMMl) '—••• 1 I FI IYa:n�' MF1Mr: F I
CY:W?YYbr,WM aILPM MN"nw. I EL U<1ti E POLfr:mn I
A ELO Liability I 030572 I 030513 Per OF,2M
aea,
I AornepatE A,000.ao
a1i41 CO ININRFMRNI:nsu rnce6rvrS onlyr eMvi Mnce Professional REMre,1Y.agYry wrt919 rpWnel
This era!Li ail of overages servos only as evidence of Professional(E&O)
General Liability coverage.
CERTIFICATE HOLDER CANCELLATION
CIT32.AP
SHOULD ANV OF THE A60vE DESCRIBED POLICIES Be CANCELLED BEFORE
City Of Ashland Public Works ' THE EXPIRATION DATE THEREOF, NOTICE VPILL BE DELIVERED IN
Attn: Mike MOfr(SOn ACCORDANCE WITH THE POLICY PROVISIONS.
90 N.Mountain Ave. AvrwwYl�Dw;reESEMrnrnE
Ashland,OR 97520
W 19884009 ACORD CORPORATION. All rights reserved.
ACORD 25(2DDSMS) The ACORD name and 1090 arc fc9151Ie1e0 marks of ACORD