HomeMy WebLinkAboutInsurance Certificate: VSS Emultech (2)
BASIC-1 OP ID: MY
CERTIFICATE OF LIABILITY INSURANCE 0 DAT4101//1'YYV)
04/01/13
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 endorsemen s .
PRODUCER CONTACT
Phone: 650-573-1111 NAME:
Andrelnl & Company-San Mateo Fax: 650J78.4361 PHONN
License 0208825 - Fuc -
220 West 20th Ave E-MAIL
San Mateo, CA 94403 ADDRESS:
Mike Brunn INSURER(S) AFFORDING COVERAGE NAIC0
INSURER A: National Union Fire Ins Co PA 19445
INSURED Valley Slurry Seal Company INSURER 9: Starr Indemnity & Liability Co 38318
dba: VSS Emultech NSURERe:State Compensation-Oregon
3785 Channel Drive
West Sacramento, CA 95691 INSURE
URER R D:
NS 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 TYPE OF INSURANCE POLICY EFF POLICY UP
LTR POLICY NUMBER MWDDIYYYY (MMADDIYYYY) UNITS
GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
A X COMMERCIAL GENERAL LIABILITY GL4522531 03101113 03101114 PREMISES Ea occurrence $ 100,000
CLAIMS-MADE FxIOCCUR MED EXP (Any one person) $ 10,000
X Deduc$1,000,000 PERSONAL &ADV INJURY $ 2,000,000
X OCIP Excluded GENERAL AGGREGATE $ 4,000,000
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG E 4,000,000
POLICY X PRO- LOD S
AUTOMOBILE 14ABIl7TY COMBINED SINGLE LIMIT
Ea-aecldam.._. 2,000,009
A X ANY AUTO CA3275122 03101113 03101114 BODILY INJURY (Per person) S
ALL OWNED SCHEDULED
AUTOS AUTOS BODILY INJURY (Per accident) $
X MIRED AUTOS X NON-OWNED PROPERTY DAMAGE $
AUTOS Per accident
X Decl.$1. X OCIP Exelu MCS 90 s Included
UMBRELLA LIAB X OCCUR EACH OCCURRENCE 5 5,000,000
B X EXCESS LIAO CLAIMS-MADE SISCCCLOOOOSS12 03/01113 03/01114 AGGREGATE $ 5,000,000
DED RETENTIONS $
WORKERS COMPENSATION WC STATU- OTH-
I TORY AND EMPLOYERS' LIABILITY
C ANY PROPMETOR/PARTNER/EXECUTNE YIN 97123 - OREGON 04101112 04101113 E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED'! ❑ MIA
(Manila" in NH) E.L. DISEASE - EA EMPLOYEE $
N es, RIPTIOe N O OF O unol
D ESCRIPTIOF OPERATIONS 0ek,w E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Addldonal Remarks Schedule, U mane space is nn,ulrM)
THIS SUPERSEDES ANY PREVIOUSLY ISSUED
CERTIFICATE FOR THIS POLICY TERM
CERTIFICATE HOLDER I~ CANCELLATION
U ASHY
rte--- 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 Drive APR - 8 2013 AUTHORIZED REPRESENTATIVE
Ashland, OR 97520
/ ' aT b o
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