HomeMy WebLinkAboutInsurance Certificate: Hooper Springs Tree Service
ACOR&
F DATE 1
CERTIFICATE OF LIABILITY INSURANCE os/1n8/2013
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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 CONSTITUTEA 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. 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 confer rights to the
certificate holder in lieu of such endoreament(s . -
PRODUCER CONTACT
NAME:
PAUL VOLZ INSURANCE AGENCY INC pX
AIC No Ext : aC No
450 SISKIYOU BLVD, STE 5 - EaM
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC
ASHLAND OR 97520 INSURER A: SCOTTSDALE INSURANCE COMPANY
INSURED INSURER B:
MATT SON INSURER C:
DBA HOOPER SPRINGS TREE SERVICE INSURER D:
11537 DEAD INDIAN RD INSURER E:
ASHLAND OR 97520 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 OFANY 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.
TR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMfDDIYYYY) (MMODDfYYYY) LIMITS
GENERAL LIABILITY - EACH OCCURRENCE $ 1,000,000.
COMMERCIAL GENERAL LIABILITY
PREMISES Ea occurrence $ 100,000.
CLAIMS-MADE I--/] OCCUR - MED EXP (Any one person) $ 5,000.
A X CPS1777506 05/22/13 05122114 PERSONAL BADV INJURY $ 1,000,000.
GENERA-AGGREGATE $ 1,000,000.
GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS -COMP/OPAGG $ 1,000,000.
POLICY ECTO" LOC $
AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT
(Ea acciden) $
ANY AUTO - - BODILY INJURY (Per person) $
ALL OWNED SCHEDULED _
AUTOS AUTOS BODILY INJURY (Per accident) $
HIREDALROS NON-OVVNED PROPERTY DAMAGE
(Per accident) $
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAR CLAIMS-MADE AGGREGATE $
DED RETENTION $ $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY YIN TORY LIMITS ER _j W=T(7
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA E. L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH) - E.L WI SE-EA EMPLOYEE $
If yes, descnba under
DESCRIPTION OF OPERATIONS Gelow E.L. DISEASE- POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, 9mom aped Is required)
TREE SERVICE
THE CITY OF ASHLAND, ITS OFFICERS, EMPLOYEES AND AGENTS SHALL BE NAMED AS ADDITIONAL INSURED PER CG2013-ADDITIONAL INSRUED -
STATE OR POLITICAL SUBDIVISIONS - PERMITS RELATING TO PREMISES.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE CITY OF ASHLAND THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
20 E MAIN ST ACCORDANCE WITH THE POLICY PROVISIONS
AUTHORIZED REPRESENTATIVE
ASHLAND OR 97520 j ~9 It -
01988-2010 ACOWfi CORPORATION. All rights reserved.
ACORD 25 (201N05) The ACORD name and logo are registered marks ofACORD