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HomeMy WebLinkAboutInsurance Certificate: Right-Of-Way Associates DYV) ,1%. R CERTIFICATE OF LIABILITY INSURANCE 4 1/12112/ 22 0 13 013 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 WANED, 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 NCONTACT AME: Marilynn Baird .7B NIBLEY INSURANCE INC PRONE: (503)221-5420 F~Np: (503)221-0732 1800 SW First Avenue, Suite 10 E-MAIL mb®aibleYinsurance. com ADRS INSURERS AFFORDING COVERAGE NAIC 0 Portland OR 97201-5398 INSURER n:Travelers Casualty Ins Co of A 19046 y INSURED INSURER B:Travelers Indemnity Co of Conn 5682 RIGHT-OF-WAY ASSOCIATES INC INSURER C:Travelers Indemnity Company 5658 10186 SW LAUREL STREET INSURER D:Charter Oak Fire Insurance Co 5615 INSURER E:Couatr ide Brokerage Services HEAVERTON OR 97005 INSURER F: COVERAGES CERTIFICATE NUMBER:CL13 13 0117 3 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 ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE I= Jim POLICY NUMBER MM/DO MMIOD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY P REMISES Es Occurrence) $ 300,000 A CLAIMS-MADE FT OCCUR X 6806717L567ACJ12 10/22/201210/22/2013 MED EXP(Any one person $ 51000 PERSONAL S ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GEWL AGGREGATE LIMB APPLIES PER PRODUCTS - COMP/OP AGG $ 4,000,000 X POLICY PRO LOC S AUTOMOBILE LIABILITY OMaBIINED SING LIMIT 11000,000 ra) B X ANY AUTO BODILY INJURY Per person) $ ALL OWNED P SCHEDULED X A6720LS1112SEL 0/22/2012 0/22/2013 BODILY INJURY (Per accident) S NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Wer iden Medical payments $ 5,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE S 1,000,000 C EXCESS LIAR CLAIMS-MADE AGGREGATE $ 11000,000 OED X RETENTIONS 5,00 X DP7876Y5231242 10/22/2012 0/22/2013 f TH_ D WORKERS COMPENSATION WCSTATU- OR AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORIPARTNER/EXECUiNE El. EACH ACCIDENT $ 500,000 OFFICERJMEMSER EXCLUDED? NIA (Mandatory In NH) OIIB6719L88612 0/22/201210/22/2017 E.L. DISEASE - EA EMPLOYE S 500,000 Cascita, der--_ SCRIPTION OF OPERATIONS below D E.L. DISEASE =POLICY LIMIT S ---SOD, ODD E Professional Liability 710 10419 10/22/201210/22/2013 1,000,000 Occurrence $2.000,000 Aggregate DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101, Additional Remarks Schedule, X more space la required) Additional Insured: City of Ashland, Oregon, its elected officials, officers, and employees, excepting the Professional Liability and Workers Compensation policies. Coverage is primary and non-contributory. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland 20 East Main St Ashland, OR 97520-1814 AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. IMCMRron, rv.m n, r~_ enr.nn