HomeMy WebLinkAboutInsurance Certificate: Rogue Waste Systems (3) 09/12/2012 3 : 16: 23 PM -0500 FAXCOM'," I PAGE 3 OF 3
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DATE(MWDDIYYYY)
acoRa CERTIFICATE OF LIABILITY INSURANCE 9/122012
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: it the certNlcate holder Is an ADDITIONAL INSURED,the pollcy(les) must be endorsed. K 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 NAM
NAMEE::
PHONE FAX
AIC No Eat (AIC'Nei:
Wells Fargo Insurance Services USA, Inc E-MAIL ADDRESS:
975 Oat(Street, Suite 900 INSURERSI AFFORDING COVERAGE NAILS
Eugene,OR 97401 INSURER A: Continental Casualty Company 20443
INSURED INSURER B:
Rogue Waste Systems,LLC INSURER C:
PO Box 3187 INSURER D:
INSURER E:
Central Point,OR 97502 1 INSURER F:
COVERAGES CERTIFICATE NUMBER: 4839529 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.
ILTp TYPE OF INSURANCE POLICY NUMBER MMMOIYYNT) (MMII)DITYNYI LIMBS
GENERALUABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY PREMISES Ea o,.nerenre $
CLAIMS MADE F-IOCCUR MED EXP(Any ma pamnn) $
PERSONAL 6 ADV INJURY $
GENERAL AGGREGATE It
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG It
POLICY PRO-,7 LOC $
AUTOMOBILELIABILITY COMBINED SINGLE LIMIT
Ea acddenl $
ANYAUTO BODILY INJURY(Par pe c.) $
ALLOWAIED SCHEDULED BODILY INJURY(Par a,ddenl) $
AUTOS NAUTOS
ON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS Par arcitlent
UMBRELLAU OCCUR EACH OCCURRENCE $
EXCESS LIAR CLAIMS�MADE AGGREGATE $
DED RETENTION$ $
WORICERS COMPENSATION WC STAN- OTH-
AND EMPLOYERS'LIABILITY YIN
AN IJFFICERIMEMBEREXCLUDED?Y PROPRIETO"ARTNER/EXECUTIVE❑ EL.EACH ACCIDENT $
NIA
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE It
f yea,daecdlx,under
DESCRIPTION OF OPERATIONS balnw E.L.DISEASE POLICY LIMIT $
A Professional Liability 425375483 5162011 5/62013 $1,000,000Pa1neim
$1.000,000 Aggregate
$2,500 Retention
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Aeach ACORD 101,Additional Removes Schedule,If mere space Is mqulmdl
Evidence
CERTIFICATE HOLDER CANCELLATION
City Of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Attn Kadann Olson THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
90 N.Mountain Ave
Ashland,OR 97520 AUTHORIZED REPRESENTATIVE
The ACOR D name and logo are registered marks of ACORD 01988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010/05)