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HomeMy WebLinkAboutInsurance Certificate: Sabel Painting Co Rte® CERTIFICATE OF LIABILITY INSURANCE OF ID DR DATE( Y 08/13/12 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(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 NAME: FAX Insurance Marketplace, Inc. ac,NO,Ext: (A/C,No): 1998 Skypark Dr Suite 100 ADDRESS: ' Medford OR 97504 CUSTOMERID#: SABEL-1 Phone:541-779-0177 Fax:FAX 772-8235 INSURER($)AFFORDING COVERAGE NAICO INSURED I INSURERA: Setif Corporation Sabel Painting Co INSURER B: Jim Sabel 3181 Old Sta a Rd INSURER C: Central Point OR 97502 INSURER D: INSURER E - - INSURER FF 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. INSH I LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDD/YYYY) (MMIDDNYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ . COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE 171 OCCUR MED EXP(My one person) $ PERSONAL S ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY JECOT n LOC $ AUTOMOBILE LIABILITY CO aBINEDt)INGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ 8 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ p� WORKER$COMPENSATION 970729 07/01/ 2 07/01/13 -YIN AND EMPLOYERS'LIABILITY TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIV E.L.EACH ACCIDENT $ SOOOOO OFFICER/MEMBER EXCLUDED? IA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE I FS THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland THORIZED REPRESENTATIVE 20 E Main St ' Ashland OR 86520 'j,i AUG 2 1 2012 vin Cope-IM ©1988.2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) - The ACORD name and logo are regi erect marks of ACORD