HomeMy WebLinkAboutInsurance Certificate: Pape Machinery
/ , ® DATE (MM/DD/YYYY)
A~ o CERTIFICATE OF LIABILITY INSURANCE 02/28/2013
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 CONTACT
MARSH USA INC. NAME: PHONE FAX
111
1115W COLUMBIA STE. 500 NC No:
PORTLAND, OR 97201 E-MAIL
ADDR
AM: Liz Whiting 503-2481204 ESS:
INSURERB AFFORDING COVERAGE NAICY
900810-05-PCAS-13-14 PM INSURER A: National Union Fire Insurance Company 19445
INSURED INSURER B; N/A NIA
PAPS' MACHINERY, INC. NIA
CIO THE PAPE' GROUP INSURER C : NIA
PO BOX 407 INSURER D: NIA N/A
EUGENE, OR 97440 Gemini Insurance Co 10833
INSURER E:
INSURER F :
COVERAGES CERTIFICATE NUMBER: SEA-001998348-32 REVISION NUMBER:2
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 ADDL SUER POLICY EFF POLICY EXP LIMBS
LTR TYPE OF INSURANCE POLICY NUMBER MM/UD/YYYY MM/DD/YYVV
GENERAL LIABILITY EACH OCCURRENCE $ 1'000'000
A X GL4309787 03101/2013 0310112014 DAMAGE TO RENTED 250,000
COMMERCIAL GENERAL LIABILITY PREMISES Eaoccunence $
CLAIMS-MADE 21 OCCUR MED EXP(Any one person) $ 25,000
X CONTRACTUAL LIAB PERSONALS ADV INJURY $ 1,000,000
X PER LOC AGG 8210 GENERAL AGGREGATE $ 10,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000
X POLICY PRO- LOC $
A AUTOMOBILE LIABILITY CA 3482083 0310112013 0310112014 EOM~BI tlEED,SINGLE LIMIT 2,000,000
E X ANY AUTO GVE 100104101 03101/2013 0310112014 BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Par accident) $
AUTOS AUTOS
NON-OWNED PROPERTVDAMAGE $
X HIRED AUTOS X AUTOS Per accitl nt
UMBRELLA UAa OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DEO RETENTION$ $
WORKERS COMPENSATION WC STATUS OTH-
AND EMPLOYERS' LIABILITY CRY T
ANY PROPRIETOR/PARTNEWEXECUTIVE V/❑N E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? N/A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYE $
It yes, 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)
RE: THE CITY OF ASHLAND, OREGON, AND ITS ELECTED OFFICIALS, OFFICERS AND EMPLOYEES ARE INCLUDED AS ADDITIONAL INSUREDS WHEN REQUIRED BY WRITTEN AGREEMENT OR
CONTRACT AS RESPECTS TO OPERATIONS OF THE NAMED INSURED.
CERTIFICATE HOLDER CANCELLATION
CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
20 EAST MAIN STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ASHLAND, OR 97520 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Elizabeth A. Whiting £uisuse .4.LLVvJ^Y
®1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD