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ACORD CERTIFICATE OF LIABILITY INSURANCE DA DDIYVYY)
9//16/2 16/2013
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: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) 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 endorsement(s).
PRODUCER CONTAC
NAME:
, FAX
Kibble & Prentice, a USI Co PR PHONE 206 441-6300
Arc No Est : A/c No : 610.362-8528
601 Union Street, Suite 1000 ADDRESS: pl.certrequest@kpcom.com
Seattle, WA 98101
INSURER(S) AFFORDING COVERAGE NAIC A
INSURER A: Hudson Insurance Company 25054
INSURED INSURER B :
OBEC Consulting Engineers, Inc.
920 Country Club Rd, #1006 INSURER C :
Eugene, OR 97401 INSURER D:
INSURER E:
INSURER F :
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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.
LTgR TYPE OF INSURANCE NADDLSUBR SR_ WVD POLICY NUMBER MM/DDNYYY MMIDDIVYYV LIMITS
GENERAL LIABILITY EACH OCCURRENCE S
COMMERCIAL GENERAL LIABILITY PAEMISES Eao Lunen. $
CLAIMS-MADE 71OCCUR MED EXP (Any one person) $
PERSONAL $ ADV INJURY $
GENERAL AGGREGATE $
GENL AGGREGATELIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $
_ POLICY PEa LOC $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
Ea accident
ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS AUTOS
NON-OWNED PROPERTY AMAGE $
HIRED AUTOS AUTOS Per .,d 'D
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAR CLAIMS-MADE AGGREGATE $
DELI RETENTIONS $
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L. EACH ACCIDENT S
OFFICER/MEMBER EXCLUDED? N/A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $
It yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $
A Professional AEE7254303 9/25/2013 09/25/2014 $5,000,000 per claim
Liability $5,000,000 annl aggr. 'Ti DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space Is required)
Re: Contract for Personal Services - Calle Guanajuato Resurfacing Project.
CERTIFICATE HOLDER CANCELLATION
City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Attn: Karl Olson ACCORDANCE WITH THE POLICY PROVISIONS.
90 N. Mountain Avenue
Ashland, OR 97520 AUTHORIZED REPRESENTATIVE
01988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) 1 Oil The ACORD name and logo are registered marks of ACORD
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