HomeMy WebLinkAboutInsurance Certificate: Bergeson-Boese & Associates CERTIFICATE OF LIABILITY INSURANCE DATE(MM DD
4/25/2012 12
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(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 NAMV CT EL15 Sutherland
Ward Insurance Agency PHONED (541)687-1117 FNAC No): (541)342-8280
P O Box 10167 .kris0wardinsurance.net
INSURERS AFFORDWG COVERAGE NAIc
Eugene OR 97440 INSURERA:Endurance American Specialty
INSURED INSURERBNationwide Mutual Ins Company 3787
Bergeson-Boese S Associates Inc, INSURER C:
DBA BBSA Environmental INSURER D:
32986 Roberts Court INSURERS:
Coburg OR 97408 INSURER F:
COVERAGES CERTIFICATE NUMBER 12/13 GL/AU/UM/POLL/PROF 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 VvHICH 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 OLS POLICY idmwa L R TYPE OF INSURANCE POLICY NUMBER MMID0efYYY MMIDO LIMITS
GENERAL LIABILIY EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY PREMISES Eeoavnence $ 50,000
A CLAIMS-MADE QOCCUR ECCIOI007042 /30/2012 /30/2013 MED EXP Any one parson) $ 5,000
PERSONAL B ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GENT AGGREGATE LIMIT APPLIESRER' PRODUCTS-COMPIDPAGG $ 2,000,000
X POLICY FRO LOC $CCT
AUTOMOBILE LIABILITY Ea accident LIMIT 11000,000
B X MY AUTO BODILY INJURY(Per Person) $
ALL OWNED SCHEDULED P7581541172 /30/2012 /30/2013 BODILY INJURY(Per dent) f
AUTOB AUTOS
X HIRED PUTOS X AUOS�ED PROPERTY DAMAGE $
Uninsured motonst combined $ 1,000,00
X UMBRELLA LAB X OCCUR EACH OCCURRENCE 11 1,000,000
A EXCESS LIAB CLAIM&MADE AGGREGATE $ 1,000,000
DEC) I I RETENTION 85101007043 /30/2012 /30/2013 $
WORHERSCOMPENSATION WC STATU- OTH-
ANDEMPLOYERS'LIABILITY YIN
ANY PROPRIETORIPARTNEREXECUTIVE❑ NIA
E L.EACH ACCIDENT $
OFFICERIMEMBFR EXCLUDED'I
(Mandatory In NH) E.L.DISEASE-FA EMPLOYE $
'If s.desal0e under
DESCRIPTION OF OPERATIONS below ELDISEASE-POLICY LIMIT Is
A POLLUTION LIABILITY ECC101007042 /30/2012 /30/2013 LIMIT. $1,000,000
PROFESSIONAL LIABILITY LIMIT: - $1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Aeach ACO RD 101,Additional Remerks Schedule,If more space Is required)
THE CITY OF ASHLAND, ITS OFFICERS, EMPLOYEES AND AGENTS ARE ADDED AS ADDITIONAL INSUREDS IF REQUIRED BY
WRITTEN CONTRACT
D E(DEDV=
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.
20 E MAIN STREET
ASHLAND, OR 97520 AUTHORIZED REPRESENTATIVE
Rob Harvey/CARSON
ACORD 25(2010105) O 1988-2010 ACORD CORPORATION. All rights reserved:
INS025(701005)01 The ACORD name and logo are registered marks of ACORD