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Home My WebLink AboutInsurance Certificate: Grayback Forestry (2) OP ID: KIY CERTIFICATE OF LIABILITY INSURANCE 01/1 D0 1111 11/201/2013 3 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 INSURERIS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: N the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. N SUBROGATION IS WANED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not corder rights to the certificate holder In lieu of such endorsements . PRODUCER Phone: 541-773-5358 NCONTACT OME: Kendall Yeaw PFOEBCI k Insurance, 'LLC PHONE FAACX' NO : 541-772-1906 POot Rock Ins Agency LLC (CA) Fax: 541-772-1906 AIL No E 541-7735358 rt: PO Box 4669 AoDRESS: Kendall rotectorsins.com Medford, OR 97501 GRAYS-1 R. Joe Hubbard CUSTOMER IDS: INSURER(S) AFFORDING COVERAGE NAIC# INSURED Grayback Forestry Inc INSURER A: American States Ins Company 19704 Western Emergency Services LLC INSURERS American Economy Insurance PO Box 838 Merlin, OR 97532-0838 INSURER C:RSUllndenmi Company 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. . ILTR TYPE OF INSURANCE POLICY NUMBER MMIDD MMIDD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL Lwalurr 01 C13111 8240 01101/2013 0110112014 PREMISES Ea wcurrence 8 1,000,00 CLAIWMADE OOCCUR NED UP (,My one person) $ 10,00 PERSONAL B ADV INJURY $ 1,000,00 X Loggers Broad PD GENERAL AGGREGATE $ 2,000;00 GEM AGGREGATE LIMIT APPLIES PER _ PRODUCTS - COMP/OP AGG $ 2,000,00 PoLlcv X 20' LOC Loggers E 1,000,00 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00 (Ea accident) B IX ANV AUTO 02CE22830410 01/01/2013 01/01/2014 BODILY INJURY(Per peron) $ ALL OWNED AUTOS BODILY INJURY IPer ecaidenl) $ SCHEDULED AUTOS FROPERIY DAMAGE $ HIRED AUTOS (Per C.denl) NON-OWNED AUTOS Pollution $ 1,000,00 BPollution 02CE22830410 01101/2013 01101/2014 $ X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 2,000,00 EXCESS LIAR CLAIMS-MADE AGGREGATE $ 2,000,00 A' 01SU41705730 01101/2013 0110112014 HDEDUCTIBLE $ RETENTION Y $ WORMERS COMPENSATION WC STATLL OTH AND EMPLOYERS'LIABILITY YIN TGRYLIMITS ER ANY PROPRIETO"ARTNERIEXECUTIVE ❑ NIA E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE- FA EMPLOYEE $ If yes. descnho under DESCRIPTION OF OPERATIONS debn E.L. DISEASE -POLICY LIMIT $ C Excess Liability HA232081 01101/2013 01/01/2014 Excess _ 3;000,00 DESCRIPTIONOF. OPERATIONS ILOCATONS/VEHICLES (Aeech ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION CITYAS2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. , 20 E Main Street Ashland, OR 97520 AUTHORIZED REPRESENTATIVE R. Joe Hubbard O 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD Act V CERTIFICATE OF LIABILITY INSURANCE °6 12!8/2012 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(tea) must be endorsed. H SUBROGATION IS WANED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this "Afficate does not Center rights to the carfificate holder in Ilou of such ondorsomen a . PRODUCER NACONTACT ME: KPD _ De. Inc. PHONE Box 784 541-7410550_ wc.Nec541-741-1674___. j Springfield OR 97477 I INSVRER(S)AFFONWXC C°VERAGE_- NAKp - _ v--._-- INaIiRERA SAIFSdT[pordtion----- _-_38]86_._ INSURED GRAY03W INSURER a~ZurichAniedcar) lnsurance_.G4. Grayback Forestry, Inc. INSURER C.__ PO Box 836 Merlin OR 97532 InsuaEn P' .INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 1058340096 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 REOUIREMENI, 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. i AD- _ OLICYEPP POLCYEla: - - - - INbR rYPEOFINSURANC6 I 018R VPA POLICY NUMBER lmmmonyry) I I LRflI& i GENERAL UABNDY EACH OCCURRENCE i$ DAM7TO-REF7TE COMMERCIAL A GENERAL LIABILITY CLAIMSN11DF VAEMIBE$iE9'A54RPf:.^l1.__,s MEO EkPIMY~ ~S (1AINS0E ~ OCCUR PERG LAA0111NIURY 3 GENERAL AGGREGATE_ $ GENL AGGREGATE LIMIT APPLIES PER I P+OIn1CT5-..OL!?qP AGGIS POLICY I PNO- 1- L(X: i S AUTOMOBILE LIABILITY " (EnW~nl1- I S NVAUTO BODILYNJURY tPAr prim) I S I ALL OWNED SCHEDULED BODILY INJURY IPA, AttJdcnll' S AUTOS AUTOS NON OV^ED HROPERTY DALIAGE HIREDAUTOS AUTOS P~rexkenti- J-f I UMSRELLALMB OCCUR EAC14 O_000RRENCF Is acm LM CLAIMS-MADE - AGGRCGATE - DCD RETENTIONS S WARNERS COMPENSATION 85806-OR 41112013 p1t/2014 ;X Wf: S1AlU OTRI A AND EMIROYERB'LIABILITY YIN 584-OR 1112013 111/2014 TORYUVIT3i .B. _ ANY PROPRIETORJPA.RTNER2X000TIVE❑ NIA EI FM.H AIXILENT S5013 OW _ orFlCCRAAEMBER EXCLUDED? (MandMOr br NN) [ L DISEYUE -FA EMP! DY 5500 0~ I? yyeess,, dMe10B Wr - DEBGRIPTION OFOPERATIONS lMtnv - EL DISEASE-POLICY LIMA ($500,000 B Workers Compemelion 9563291(MULTI STATE) /1/7013 11,7014 1EL Each Accial $1,000.000 f and Empklyols LlabBty Limits EEt Di~ EA $1.000.0XI L Dim w Policy 51.000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Anwh ACORD 101, AddMmW Rtr , Sehtdult, a Mm tptct 4 rtqul W) Re: All Operations CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main Sheet Ashland OR 97520 AUINORLEED REPRESENTATIVE 019BO.201 D ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD