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HomeMy WebLinkAboutInsurance Certificate: Xen 1 Inc ---ON CHOWN-3 OP ID: KI CERTIFICATE OF LIABILITY INSURANCE DA 12/28/11 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 policy(ies) 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 503.274.6511 CONTACT Fullerton&Company 503-274-6524 PHONE P.O.Box 29018 INC. FAX No EXt: ac No: Portland,OR 97296.9018 E-MAIL Tim Nielsen ADDRESS: INSURER(S) AFFORDING COVERAGE NAICN INSURER A:SAIF Corporation INSURED Xen 1,Inc. INSURER B: Go Xenium Resources 7401 SW Washo Court#200 INSURER C: Tualatin,OR 97062 INSURER D: NSURER E: NSURERF: COVERAGES CERTIFICATE NUMBER: 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 MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL UB POLICY NUMBER MMIDDY LTR IYYYY MMMOrYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE ❑OCCUR MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ GENT AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OPAGG $ JECT POLICY PRO- LOC $ 1-1 AUTOMOBILE IJABILITY COMBINED SINGLE LIMIT Es accident $ ANY AUTO BODILY I NJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS NON OMED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Perawdern 8 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ 1 IS WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY T Y IT ER A ANY PROPRIETORIPARTNERIEXECUTIVE YIN 949996 01101112 01/01/13 E.L.EACH ACCIDENT s 1,000,000 OFFICER/MEMBER EXCLUDED? F-1 N/A (MandsWly In NH) - -- E.L.DISEASE-EA EMPLOYE S 1,000,000 If yes,describe under DESCR191ON OF OPERATIONS del. E.L.DISEASE-POLICY LIMIT I S 1,000,000 IT, DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Anson ACORD 101,AddWonal Remarks Schedule,a more space Is required) As respects the operations of Chown,Inc.333 NW 16th Ave,Portland OR, 97209,Client#950928 CERTIFICATE HOLDER CANCELLATION CITYASH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CI Of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City ACCORDANCE WITH THE POLICY PROVISIONS. Purchasing Representative Karl Olson AUTHORIZED REPRESENTATIVE 90 N.Mountain Avenue "b Ashland,OR 97520 � w\% Ql'vX:,c aR:.fi t_, I I ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD