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HomeMy WebLinkAboutInsurance Certificate: Pubilc Works Management OP ID: TP CERTIFICATE OF LIABILITY INSURANCE DATii//o /12YY) 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 NCONTACT Therese Pritchett United Risk Solutions, Inc. 541-245-1112 PHONE A1c.NS~ Ei C. N.): 541-245-1112 PO Box 936 541-494-7744 Medforcl-OR 97501-0067 E-MAIL ADDRESS, therese.pritcheft@unitedrisk.com Workers Comp House Account PRODUCER .PUBL0IW SUSTQMERIp . INSURER(S) AFFORDING COVERAGE NAIC e INSURED Public Works Management, Inc. INSURER A: SAW Corporation C/O RH 2 Engineering INSURER B: 22722 29th Dr SE Ste 210 Bothell, WA 98021 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. TR Y LIMITS INSR TYPE OF INSURANCE POLICY NUMBER MMIDDmYY MMIDDNYV GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISESGETE.Eo~uwrence $ CLAIMS-MADE OCCUR MEDEXP(Anyoneperson) $ PERSONALBADVINJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMPMP AGG $ POLICY PRO- LOC $ JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODI LY INJURY (Per person) $ ALLOWNEDAUTOS BODILY INJU RY(Per accident) $ SCHEDULEDAUTOS PROPERTY DAMAGE HIREDAUTOS (Per accident) $ NON-0WNEDAUTOS $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CI-AIMS-MADE AGGREGATE 8 DEDUCTIBLE $ RETENTION $ Is WORKERS COMPENSATION X WCSTATU- OTH- AND EMPLOYERS' LIABILITY T RY LIMITS ER A ANY PROPRIETORIPARTNER/EXECUTIVEY NIA 967233 11/01/12 11/01113 E.L. EACH ACCIDENT $ 500,090 OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E. L. DISEASE-FA EMPLOYE $ 590,000 If yes. describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES `ANach ACORD 101, Additional Remarks Schedule, if more .pelt. la required) RE: ALL OPERATIONS OF THE NAMED INSURED CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland FR v THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 E Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 975 NO 9 2012 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and load are registered marks of ACORD