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HomeMy WebLinkAboutInsurance Certificate: Pump Pipe & Tank SRVCs PUMPP-1 OP ID: C1 CERTIFICATE OF LIABILITY INSURANCE 1 DAT 10/1DD/YYYY) on7n2 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 endorsements). PRODUCER 817-640-5035 CONTACT Monroe&Monroe Insurance 817-640-0131 w°NE FAx Agency, Ltd. Lyno Er: ac No): 2921 Galleria Dr., Suite 102 EMAIL Arlington,TX 76011' -- - - ADDRESS: Jim Beam,CIC INSURER(S)AFFORDING COVERAGE NAIC p INSURER A:Mid-Continent Casualty Co. 23418 INSURED Pump Pipe&Tank Services LLC INSURER B: Bob McHenry dba Pump Pipe& Tank Services INSURER C: Bob McHenry INSURER D: Box 146 Talent,OR 97540 INSURER E INSURER F 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. INSR TYPE OF INSURANCE ADDL S�II eR POLICY EFF POLICY E%P LTR I POLICY NUMBER MM/UDYYYY I fMMfDDffYYY1 LIMITS GENERAL LIABILITY EACH OCCURRENCE Is 1,000,00 A X COMMERCIAL GENERAL LIABILITY 04GL862756 11115/12 11/15/13 DA MA�TO REN ED 100,00 PREMISES KENT rcence $ CLAIMS-MADE FX] OCCUR MED EXP(Any one person) $ X Pollution Llab PERSONALS ADV INJURY $ 1,000,00 X Professional Llab GENERALAGGREGATE $ 3,000,00 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG $ 3,000,00 X POLICY PRO LOC $ AUTOMOBILE LIABILITY Ee BINEDtSINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $AUTOS HIR DSAUTOS AUTOSWNED Parr acEraftdantDAMAGE $ I $ UMBRELLA LIAR OCCUR EACH OCCURRENCE Is EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WCRSLITI`- OTRH- AND EMPLOYERS'LIABILITY ANY PROPRIETOWPARTNERIEXECUTIVE Y/N E,I.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) EE LL.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS Eelow E .DISEASE-POLICY LIMIT $ A Equipment Floater '041M49352 - 11115112 11115113 Owned-Equ 4,90 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,it more space Is required) CERTIFICATE HOLDER CANCELLATION CASHLAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE (:l of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City ACCORDANCE WITH THE POLICY PROVISIONS. 20 E. Main Street Ashland,OR 97520 AUTHORIZED REPRESENTATIVE vmw ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD