HomeMy WebLinkAboutInsurance Certificate: Dry Creek Landfill US/1L/201'1 1 : 06 : 06 PM —0'100 FAXCOM PAGE 3 OF 3
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CERTIFICATE OF LIABILITY INSURANCE °"9/1220, '2"'
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 CONTACT
NAME:
RHONE FAX
AIC N AX;
Wells Fargo Insurance Services USA, Inc EMAIL o Exi) No):
ADDRESS:
975 Oak Street, Suite 900
INSURER(S)AFFORDING COVERAGE NAIC9
Eugene,OR 97401 INSURER A: Greenwich Insurance Company 22322
INSURED
INSURER B:
Dry Creek Landfill, Inc.
PO BOX 3187 INSURER C:
INSURER D:
INSURER E:
Central Point,OR 97502 1 INSURER F:
COVERAGES CERTIFICATE NUMBER: 4839528 REVISION NUMBER: See below
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
LTR TYPE OF INSURANCE InH WVD POUCYNUMBER MMIDDnP`YY MMMD/YYYY LIMIT$
A GENERAL LIABILITY GECO03582701 EACH OCCURRENCE $ 1.000.000
10/1/2012 10/12013
X COAPAERCIAL GENERAL LIABILITY PREMISES Pe occurrence $ 100.000
CLAIMSMADE OOCCUR MED E%P(Any ono par.) $ 5,000
X $1000 aIRD Deeud. PERSONAL 8 ADV INJURY E 1,000"000
GENERAL AGGREGATE $ 2000,000
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS"COMP/OP AGO $ 2,000,000
POLICY PRO- LOC $
AUTOMOBILELIABILITY COW NED SINGLE LIMIT
Sa accident
ANYAUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED
AUTOS AUTOS BODILY INJURY(Per accicen0 $
HIRED AUTOS NON-0W 03 PROPERTY DAMAGE
AU O$ $
Per apcLlenl
A X UMBRELLA LIAR % OCCUR UECO03582501 1011/2012 10/12013 EACHOCCURRENCE $ 3.000,000
IXCESS DAB CLAIMS"MADE AGGREGATE g 3.000,000
OED RETENTIONS $
WORKERS COMPENSATION WC STAN- OTH-
AND EMPLOYER$LIABILITY YIN 7 AT MI
ANY PROPRIETOILPARTNEILEXECUTWE
OFFICER/MEMBER EXCLUDED] N/A rFL.EACH ACCI DENT Nda..abry in and DISEASE-EA EMPLOYEE $
a Yes, IPTI Nunder DESCRIPTION OF OPERATION$belgv ISEASE"POLICVLIMIT $
DESCRIPTON OF OPERATIONS I LOCATIONS I VEHICLES (Ae¢h ACORD 101,Additional Remarks Schedule,amore space is required)
City of Ashland its Officers,agents and employees are added as additional insureds.
CERTIFICATE HOLDER CANCELLATION
City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Alin City Administrator THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
20 E Main
ACCORDANCE WITH THE POLICY PROVISIONS.
Ashland OR 97520
AUTHORIZED REPRESENTATIVE '^Y
9/ ' �
The ACORD name and logo are registered marks of ACORD O 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105)