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HomeMy WebLinkAboutInsurance Certificate: Rogue Waste Systems 263583 A CERTIFICATE OF LIABILITY INSURANCE 9 DATE (MMIDG/YYYY) 9/25/2013 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 endomement(s . PRODUCER CONTACT NAME: PHONE FAX JAIC, No. NC No Wells Fargo Insurance Services USA, Inc EWAIL ADDRESS: 975 Oak Street, Suite 900 INSURERS AFFORDING COVERAGE NAIL # Eugene, OR 97401 INSURER A: Greenwich Insurance Company 22322 INSURED INSURER 8: SAIF Corporation 36196 Rogue Waste Systems, LLC INSURER C PO Box 3187 INSURER 0: INSURER E: Central Point, OR 97502 INSURER F: COVERAGES CERTIFICATE NUMBER: 6615689 REVISION NUMBER: See below 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 ADDL =BR POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDDIYYYY MM/DD/YYYY LIMITS INSR GENERALUABILITY EACH OCCURRENCE $ 1,000,000 A GE0003582702 1011/2013 1011/2014 X COMMERCIAL GENERAL LIABILITY PREMISE ESE S S (Ea RENTED occurrence $ 100,000 CLAIMS-MADE lil OCCUR MED EXP (Any one person) $ 5,000 X $1,000 BI/PD Deduct. PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000.000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2.000.000 POLICY PRO- LOC $ IF'T AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea actltlentANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X WC STATIJ- OTH- B AND EMPLOYERS'LIABIUTY YIN 519473 10/1/2013 10/1/2014 ANY PROPRIETOWPARTNERIEXECUTIVE ❑ N/A E.L. EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE- EA EMPLOYE $ 500,000 If y s, describe under DESCRIPTION OF OPERATIONSbelow E.L. DISEASE - POLICY LIMIT S So0,W0 T DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarl s Sclladule, it more space is required) Evidence CERTIFICATE HOLDER CANCELLATION Ashland Police Dept. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1155 East Main St. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUrHORIZED REPRESENTATIVE 00 .n The ACORD name and logo are registered marks of ACORD © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) 111111111111111111111111111111111 I I 11111111111111111111111111111111111111111111111111111 -CYBa1AYJJWerfi.OlA2eNDD• Wells Fargo Insurance Services USA, Inc 975 Oak Street, Suite 900 Eugene, OR 97401 Ashland Police Dept. 1155 East Main St. Ashland, OR 97520 ##****#*t*#1t!**flfflfllfiifrt!!##!#Yff#rtrt*##**********f***+#**f+!llflf!llflYlfYfYY#f##*##********+f***lf+ff*#RR1flf! Would you like to receive this certificate via email or fax? We offer expedited delivery to better serve our mutual clients. To update the delivery method for revisions to this certificate and for next year's copy, please enter this information in your browser: https://www.cybersure.com/cybersure/forms/iyoc/cdmu.aspx When prompted, enter this information for security purposes: Client ID: 263583 Carl ID: 6615689 Passcode: 3418B206 Follow the instructions and let us know your delivery preference. You'll receive future copies of this certificate via the method you provide. Thank you for helping us provide certificates to you more quickly. a#as*++l+ff++l1f11+#lf11f!!f»1fl111ff11flflf#f#*rta++*f**l+fff++l11!!f»»f11!#Y#rt#flrtY1#rt**+***+f+ff*++*f*f+1*!++l1 I VIII III II I IIIIIII IIII IIIIiI IIII III II IIII II IIII II IIII I IIII 'CYBO1R25000BI6OIq}.4pgp'