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HomeMy WebLinkAboutInsurance Certificate: Paul Striffler E(7112 YVYY) A~ O® CERTIFICATE OF LIABILITY INSURANCE lDATvnnz 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(les) 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 NAMEADT Underwriting Dept. Tower Risk Management Corporation PHONE 800-417-4577 Fac N.11 954-489-9389 a member of Tower Group Companies EINC. N, EAI -MAIL 500 West Cypress Creek Road, Suite 500 ADDRESS: taxi@twrgrp.com Fort Lauderdale, FL 33309 INSURERS AFFORDING COVERAGE NAICIf Phone: (800) 417-4577 Fax: (954) 489-9389 INSURERA: Preserver Insurance Company 15586 INSURED INSURER B : PAUL STRIFFLER INSURER C : 1750 DELTA WATERS RD.,SUITE 102-275 INSURER D: MEDFORD OR 97504 INSURER E: ..URER 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR rypE OF INSURANCE ADDL SUBR POLICY NUMBER MMIDDY EFF M .IC NY VV LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE E N COMMERCIAL GENERAL LIABILITY PREMISES Ea occune,xs E CLAIMS-MADE F-IOCCUR MEDEXP(Anyomperaon) E N N PERSONAL S ADV INJURY E GENERALAGGREGATE E GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGO E POLICY PRO- 71 LOG $ AUTOMOBILE LIABILITY COMBINEDSINGLELIMIT E 500,000 Ea attitlent ANY AUTO 0Deductible BODILY INJURY (Per person) E A AUTOOS`MED X AUTOSULEO Y N SAPBZ0551912 12/14/2012 12/1412013 BODILY INJURY (Per emiaenq E NON-0OMEO PROPERTY DAMAGE E HIREDAUTOS AUTOS Per ac dint E H UMBRELLA LIAR OCCUR EACH OCCURRENCE E EXCESS LIAR CLAIMS-MADE N N AGGREGATE E DED RETENTIONS E WORKERS COMPENSATION WC STATU- OTH-LIMITS ~ RV AND EMPLOYERS' (ABILITY - - MYPROPRIETORIPARTNERIEXECUTIVE YI❑N NIA E.L. EACH ACCIDENT E OFFICHMEMSER EXCLUDEDT (Mandatory In NH) E.L. DISEASE - EA EMPLOYE S If yea, dewiDi, antler E. L. DISEASE - PDLICV LIMIT E M%QRIPTION OF OPERATIONS WI, A Uninsured Motorist Y N BAPBZ0551912 12/14/2012 1211412013 25,000150,000/ DESCRIPTION OF OPERATIONSI LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If nn n space I. rpaired) 20001 FORD / 2FAFP71 W7YX1248221 CERTIFICATE HOLDER CANCELLATION CITY OFASHLAND PUBLIC WORKS DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 E. MAIN STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ASHLAND OR 97520- ACCORDANCE WITH THE POLICY PROVISIONS. Additional Insured AUTHORIZED REPRESENTATIVE ©1988-2010 A CORD CORP TION. All rights reserved. ACORD 25 (2010/05)_.. The ACORD name and logo are.registered marks of ACORD