HomeMy WebLinkAboutInsurance Certificate: Peck Smiley Ettlin Architects
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CERTIFICATE OF LIABILITY INSURANCE 03TE18D2013
THIS CERTIFICATEIS 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 ADDITIONALINSURED, the policylies) must be endorsed. If SUBROGATIONIS 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
NAME
FULLERTON & COMPANY INC/PHS PHONE FAX
709437 P: (866)467-8730 F: (877)905-0457 LAIC No, (866)467-8730 AIC,Np): (877)905-045
1-W 1:
PO BOX 33015 ADDRESS:
SAN ANTONIO TX 78265 NSURERISI AFFORDING COVERAGE NAICk
INSURERA: Hartford Casualty Ins Co
INSURED
INSURER B
PECK, SMILEY, ETTLIN ARCHITECTS INC. INSURER C:
NED PECK, STEVE SMILLEY, & HANS ETTLIN INSURER D:
4412 SW CORBETT AVE
PORTLAND OR 97239 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.
LTN TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDD/YYYY) (MMIDDIYYYY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE 2202h0
2, OOO
COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) S 30A CLAIMS-MADE I X I OCCUR ~y~ _ MED EXP (Any one person) 5 10, 000
X General Liab L`J u 52 SBA UL7992 04/01/2013 04/01/2019 PERSONAL BADVINJURY S 2 000, 000
GENERAL AGGREGATE a 4,000, 000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO s 4,000, 000
POLICY I X PRO u LOC $
JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 2, 000, 000
Es accident)
BODILY INJURY (Per Person) $
ANY AUTO _Iu I_
A ALL OWNED SCHEDULED u 52 SBA UL7992 04/01/2013 04/01/2014 BODILY INJURY (Par aceidem) $
AUTOS u AUTOS
X HIRED AUTOS ~}1~~~~ NON OWNED PROPERTY DAMAGE $
LX AUTOS (Per accident)
$
UMBRELLA LIAB a OCCUR I I EACH OCCURRENCE $
EXCESS LIAR CLAIMS-MADE L-.J u AGGREGATE $
DE RETENTION $ $
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS' LIABILITY YIN TORY LIMITS ER
ANY PROPRIETOR/PARTNERIEXECUTIVEI ' 1 E.L. EACH ACCIDENT 5
OFFICERIMEMBER EXCLUDED? L-1 N/A u
(Mendetory in NH) E.L. DISEASE - EA EMPLOYE 5
It yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S
HL
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required)
Those usual to the Insured's Operations.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
City of Ashland, Off iCETS BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE
Employees and AJ DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
20 East Main Stre APR 2013 AUTHORIZER PRESENTATIVE
Ashland, OR 9752 ~9-Z- 7R
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