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HomeMy WebLinkAboutInsurance Certificate: Public Works Mgmt OP ID: MP CERTIFICATE OF LIABILITY INSURANCE 1 DATE F 11102/12 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 endorsement(s). PRODUCER 541-245-1111 CONTACT Marcia Pollman United Risk Solutions, Inc. NAME: PHONE Ax PO Box 936 541-245-1112 AID, mOEXt:541-245-1111 aCNa541-245-1112 Medford, OR 97501-0067 EWAIL S: Marcia.Pollman@unitedrisk.com der Jackie K. AIT It rg - PRODUCER CUSTOMER ID ,PU BLOIC INSURER(S) AFFORDING COVERAGE NAIC If INSURED Public Works Management, Inc. INSURERA: Valley Forge Insurance Co. 22722 29th Dr., SE, Ste. 210 INSURERS; Beazley Insurance Company Bothell, WA 98021-4401 INSURER C INSURER D : 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 SUB POLICY NUMBER MM/DDIY E E LTR YYY MMIDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 A X COMMERCIAL GENERAL LIABILITY B4017835216 11103/12 DAMAG E PREMISES Ea ocwnance $ 300,000 CLAIMS-MADE FX ]OCCUR MED EXP (Any one person) $ 10,000 PERSONAL B ADV INJURY $ 2,000,000 GENERALAGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG $ 4,000,000 -1 JECT POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 A ANY AUTO B4017835216 11/03112 11103/13 (Ea accident) BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE X HIREDAUTOS (Per accident) $ X NON-OWNEDAUTOS $ UMBRELLALIAS OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ S WORKERS COMPENSATION WC STATU OTH- AND EMPLOYERS' LIABILITY YIN TORY LIMITS ER ANY PROPRIETORIPARTNEWEXECUTIVE E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑ NIA (Mandatory in NH) EL DISEASE-EA EMPLOYE $ If yes• describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE-POLICY LIMIT $ B Professional TO BE DETERMINED 11103/12 11/03113 Per Claim 1,000,000 Liability E&O Aggregate 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, B more space is required) CERTIFICATE HOLDER CANCELLATION CITAS03 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 E Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATVIE r ~.+~.c.J~.I.+v © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD