HomeMy WebLinkAboutInsurance Certificate: Kistler Small White Architects From: lndemnity Excess & Surplus 503 626 2260 08/29/2012 14:43 #737 P.001 /001
® CERTIFICATE OF LIABILITY INSURANCE °ABE1z9/2012
ACORl�
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. It 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 Indemnity Excess & Surplus NAME: Asher CONTACT
Agency, Inc. PNONE (541) 857-0679 FAA (541) 857-9883
1500 NW Bethany Blv EAFC,,Nq No):
Beaverton OR 97006 ADDRESS_ jashereashlandinsurance.cam
INSURER(S)AFFORDING COVERAGE NAIL9
INSURERA: BEAZLEY INSURANCE COMPANY
INSURED KISTLER SMALL WHITE INSURERS:
ARCHITECTS INSURER C
545 A STREET - INSURER D:
ASHLAND OR 97520
INSURER E'
INSURER F:
COVERAGES CERTIFICATE NUMBER: 00036055 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 CONDITONS OF SUCH POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE POLICY NUMBER MMID WEFFY MMILDD
POLICY LIMITS
R
GENERAL LIABILITY EACH OCCURRENCE E
COMMERGALGENERALLIABILITY PREMISES(Ea omurrence $
CLAIMSMAOE 17 CCCUR MED EXP(My one person) $
PERSONAL L ADV INJURY $
GENERAL AGGREGATE E
GENL AGGREGATE UWIT APPLIES PER PRODUCTS COMPAPAGG S
POLICY FRO- LOC $
AUTOMOBILE LIABILITY COMBINED 81 NG L
(Fa amldenq__ E_
ANY AUTO BODILY INJURY(Per Person) $
ALL OWNED SCHEDULED BODILY INJURY Per accident) E
AUTOS Nu NON-0 $
WNEO PROPERTY DAMAGE
HIRED AUTOS AUTOS /Per acciden0
I I I$
UMBRELLA LIAR CURI EACH OCCURRENCE S _
EXCESS LIAB CLAIMSMADEi AGGREGATE S
DED RETENTIONS $
WORKERS COMPENSATION T RY LIE1 __nTH
AND EMPLOYERS LIABILITY YIN
AN PROPRIETORIPARTNEA/IXECUTIVE❑ N rA E L EAGV ACCIDENT E - _____ -_,
OFYHCERIMEN18ER EXCLUCED?
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE/S
IF}gas,desabe unax '— -'--
DESCRIPTIONOFOPERATIONSbelow E.L.DISEASE-PoLICY LIMIT I$
A X Professional V10 0 74110 3 0 1 iQ/27/2011 10/27/20121 $1,000,000 Per Claim
A X Liability V10074110301 10/27/201110/27/2012 $1,000,000 Aggregate
DESCRIPTION OF OPERATIONS/LOCATIONS)VEHICLES(Attach ACORD 101,Additional Remans ScheGule,amore space is rmluired)
claims Made Policy
Deductible: $8500 ,
Retro Date: 10�27/2009
CERTIFICATE HOLDER CANCELLATION
City Of Ashlan / a V �C. SHOULDANY OFTHE ABOVE DESCRIBED POLICIES BECANCELLED BEFORE
20 East Main S 9 l"J v Li THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Ashland ACCORDANCE WITH THE POLICY PROVISIONS.
AUTKORIZED REPRESENTAITVE
AUG 3 0 2012
D 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105) The ACORD name and logo re registered marks of ACORD
(OIANI7( RT004-71080811 2 0829 143%1)