HomeMy WebLinkAboutInsurance Certificate: Lomakatsi Restoration Project
LOMAK-1 OF ID: KIY
ATE (I011dJDDNYYY)
AI~RO• CERTIFICATE OF LIABILITY INSURANCE 0
7102/2013
07!02/2013
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: N the certificate holder Is an ADDITIONAL INSURED, the pollcylles) must be endorsed. N 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 Phone: 541-7735358 NAME: Kendall Yeaw
Protectors Insurance, LLC Fax: 541-772-1906 PMONOE :541.842-2963 FAX
Pilot Rock Ins Agency LLC (CA) Nn):541-772-1906
PO Box 4669 ADDRESS: kendally@protectorsins.com
Medford, OR 97501
R. Joe Hubbard INSURER(S) AFFORDING COVERAGE NAICs
INSURERA: American States Ins Company 19704
INSURED Lomakatsi Restoration Project INSURERS: American States of Texas
PO Box 3084 INSURERC:SAIF Cor oration
Ashland, OR 97520
INSURER D:
INSURER E:
NSURER 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.
LTR TYPE OF INSURANCE POLICY NUMBER MIDD Alp LIMBS
GENERALL 11-r1Y EACH OCCURRENCE $ 1,000,0
A X COMMERCIAL GENERAL LIABILITY X 25CC1600447 0411712013 04/1712014 PREMISES Es mcvrence $ 1,000,00
CLAIMS-MADE O OCCUR WED EXP (MY mle Derwn) f 10,00
X Owner/Cont Prot. PERSONAL s ADV INARY f 1,000,00
X Loggers BFPD GENERAL AGGREGATE $ 2,000,00
GENL AGGREGATE LIMIT APPLIES PER'. PRODUCTS -COMPIOP AGG $ 2,000,00
POLICY X PRO- LOC S
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
Es f 1,000,00
ecaOerrt
B ANY AUro 04CC2285274 04117/2013 04/17/2914 BODILY WARY (Per Person) $
ALL OWNED SCHEEX IED
AUTOS AUTOS BODILY INJURY (Par accitlen[) §
X
NON.OWNED DPA E
X HIRED PUrOS X AUTOS Per Model §
S
X UMBRELLALUB X OCCUR EACH OCCURRENCE § 2,000,00
A EXCESS LIAS C AIMSMADE OISU3691439 041172013 0411712014 AGGREGATE E 2,000,00
DED X RETENTION 10,000
E
WORKERS COMPENSATION X WC TATUB TH
AND EMPLOYERS' LIABILITY _
C ANY PROPRIErORPARTNEREXECUTIVE Y❑ NIA 992153 04/012013 04/012014 E.L. EACH ACCIDENT f 500,00
OFFICERMIEMBER EXCLUDED?
(Mwdetory In NH) E.L. DISEASE - EA EMPLOYE $ 500,00
If yes, describe antler
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT f 500,00
DESCRIPTION OF OPERATIONS J LOCATIONS I VH ICLES (AtlacK ACORD 101, Addltbntl Renn l z Sche , If mm epece Is r nnl)
additional insured per policy endorsement CG7635(0207):
CERTIFICATE HOLDER CANCELLATION
CITYAS2
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 E Main Street
Ashland, OR 97520 AUTHOR® REPRESENTATIVE
R. Joe Hubbard
O 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD