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HomeMy WebLinkAboutInsurance Certificate: Welburn Electric OP ID: KIY CERTIFICATE OF LIABILITY INSURANCE 1 O2/201201YY) z/zo/zolz 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 CONTACT Phone: 541-773-5358 NAME: Kendall Yeaw Protectors Insurance, LLC PHONE FM Pilot Rock Ins Agency LLC (CA) Fax: 541-772-1906 ac No 1541-773-5358 ac No: 541-772-1906 PO Box 4669 E-MAIL ADDRESS: kendally@protectorsins.com Medford, 97681 PRODUCER WELBU-1 R. Joe Hubbard CUSTOMER ID a: INSURE S AFFORDING COVERAGE NAIL a INSURED Welbum Electric Inc INSURER A: North Pacific Insurance 23892 PO Box 329 INSURER B Phoenix, OR 97535 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 A TYPE OF INSURANCE POLICY NUMBER MM/DDY /YYBEE YY MM/DD V /YYYY LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,008,08 A X COMMERCIAL GENERAL LIABILITY C20127353 1212312012 12123/2013 PREMISES Ea occurrence $ 100,00 CLAIMS-MADE Fx_1OCCUR MED UP (Any one person) $ 5,08 PERSONAL S ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 2,000,00 POLICY X PRO LOC $ JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00 (Ea accident) A X ANY AUTO 020127353 12123/2012 12123/2013 BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per a«ideM) $ SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per accident) $ X NON-OWNED AUTOS $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ STATU- WORKERS COMPENSATION YIN WC LIMIT 0TH- AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIUECUTIVE EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA (Mandatory in Ni E. L. DISEASE - EA EMPLOYEE $ Use, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION CITYAS2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ci of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN tY. ACCORDANCE WITH THE POLICY PROVISIONS. 20 E Main Stir Ashland, OR 97520 AUTHORQED REPRESENTATNE R. Joe Hubbard ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD