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HomeMy WebLinkAboutInsurance Certificate: Taylor Site Development TAYL02C OF ID: MKA D 9 /2 312 01 3 V) CERTIFICATE OF LIABILITY INSURANCE 09/23/2013 0 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 Phone: 541-245-1111 CONTACT Marcia Aho NAME: United Risk Solutions, Inc. PHONE PO Box 936 Fax: 541-245-1112 a IN Ea:541-245-1111 ac No)' 541-246-1112 Medford, OR 97501-0067 Aouaess: marcia.aho unitedrisk.com Jim R. Cox INSURERS AFFORDING COVERAGE NAIC d INSURER A : West American Insurance Co. INSURED Taylor Site Development Inc. INSURERS: American Fire & Casualty 24066 P.O. Box 537 INSURERC: Medford, OR 97501.0036 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 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 DL 51110 POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDDNYYY MMIDD/YVYY LIMITS MIR GENERAL LIABILITY EACH OCCURRENCE E 1,000,00 A X COMMERCIAL GENERAL LIABILITY X BKW1354278864 10/0612013 10/06/2014 PRAMAG EMISES EFENC Er ante E 1,000,00 CLAIMS-MADE OCCUR MEDEXP(Anyoneperson) $ 15,00 PERSONAL B ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 2,000,00 POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea ecoidenl $ 1,000,00 B X ANY AUTO X BAA1364278864 10106/2013 10/08/2014 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per acciOenN $ HIRED AUTOS NON-OWNED PROPERTVDAMAGE $ AUTOS Par acgdenl E UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTIONS E WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y/ N IT ANY PROPRIETOR/PARTNERIEXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A (Mandatory In NH) E.L. -DISEASE-EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Ramada, Schedule, If mom space Is required) Re: Nature Center Addition at North Mountain Park The City of Ashland, Oregon, and its elected officials, officers and employees are Additional Insured per form CABB10 01/10 and CG8811 10/09; coverage is Primary and Non-Contributory for General Liability. Cancellation per form CG8061 05/11. CERTIFICATE HOLDER CANCELLATION CITAS03 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 E Main Street Ashland, OR 97520-1814 AUTHORIZED REPRESENTATIVE Jim R. Cox ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD