HomeMy WebLinkAboutInsurance Certificate: Rogue Waste Systems (2) UJ/1Z/ZU1Z 1 : Ub: lb PM —U'/UU hAXCUM PAGE 3 OF 3
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11° O® CERTIFICATE OF LIABILITY INSURANCE °"9/12/2012
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 Pollcy(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 CONTACT
NAME'
PHONE FAX
(NC
Wells Fargo Insurance Services U54,Inc NC No Em____ ______ NOL EMAIL
ADDRESS: ___
975 Oak Street,Spite 900 NSURERISI AFFORDING COVERAGE __ NAIC 0
Eugene,OR 97401 INSURER A_ Greenwich Insurance Company 22322
INSURED
Rogue Waste Systems,I INSURER B__ XL Specially Ins_wance Company J7885
INSURER C'. SAIF Corporation 36196
PO Box 3187 "----'"-
INSURER 0:
INSURER E:
Central Point,OR 97502 INSURER F
COVERAGES CERTIFICATE NUMBER. 4839532 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 D°_SCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR - PDLICYErrTPOLfbV
LTR TYPE OF INSURANCE POLICYNUMBER IMMRIO/YYYY 'MM n]DIYYYY LIMITS
LIA&CITY L
A GENERA GECO07582701 101112012 i 10118013 I FACT n OCCURRENCE s 1.000,000
X
COMMERCIAL GENERA(LIABILITY PREMISES iEa xcwrercel 8 100,000
CIAIMB MADE (OCCUR ,IVF.DrXI` AnVO r.Isom ; $,000
X EI ODO SI,rDDedun _ _ I (PERSONAL SADV—INJURY $ '1AOgW0
G Nr.RA1 AGGREGATE_ 8 2.000,000
GEN'L AGGREGATE LIMB APr•LIrS PE R' -I rNOOOCTS comrpPAGG IS 2.000000
POLICY PRO (--' -.
,i I LOC —I 3
B AUTOMOBILELIASILITY I AE0003582401 'II 1011/2012 10/112013 I COMBINED SINCIELIMIT
,.1E.¢_acogecJ ; 1 000,000
x ANY AUTO I BOOZY INJURY(Per onn.) S
ALL OVVNEC SCHEDULED AUTOS AUTOS I BOOZY INJURY IPeraccldentl s
HIRED AUTOS NONOWNEC I j DAMAGE
AUTOS PROPERTY ry Y S
1 I 3
UMBRELLA LIPS OCCUR
. `EAC.H000URRENCE_ E
EXCESS LA CLAIMS MADE AGGREGATE S
OED RETENTION $
WORKERS COMPENSATION , Wr.STATU OTH
C AND EMPLOYERS'LIABILITY 519473
vJN 10/1/2012 10/1/2013 __..!CR I I
PNYCERAMEETORPAflTNERIFXECUINE i 500,000
OFFICERIMEMRER EXCIUDED2 NrA, I el EACH ACCIDENT S
(Mandalnry In NH)) DEL CISFABE-EAFMPLOYEES 500.0110
If yes,nescnbe urw
DESCRIPTION OF OPERATIONS bclva' I j Et DISEASE-rCLICY LIMIT E 500.000
DESCRIPTION OF OPERpTONBrLOLATIDNS IVENILLES 1Ahach ALORO 101.Atltlillpnal RemaMS Schedule,if more Pace is repulrtdl
The City of Ashland,Oregon and ils elected Officials,officers and employees are listed as additional insureds but only with respects tolhe services
provided by Rogue Shred,I
CERTIFICATE HOLDER CANCELLATION
City Of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
20 East Main SL THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED W
Ashland,OR 97502 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE I -
The ACORD name and logo are registered marks of ACORD (11958-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010 105)