HomeMy WebLinkAboutInsurance Certificate: Lomakatsi Restoration
LOMAK-1 OP ID: KIY
IMMODAY
6126/20101 YY
'4~CO~~OA CERTIFICATE OF LIABILITY INSURANCE 1 60/1
1 10/13
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(les) 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: 541-773-5358 NCONTACT
AME: KendallYeaW
Protectors Insurance, LLC PHONE FAX
Pilot Rock Ins Agency LLC (CA) Fax: 541-772-1906 NC NA Exe: 541-842-2963 WC Na: 541-772-1906
PO Box 4669 ADDRESS: Kendall protectorsins.com
Medford, OR 97501
R. Joe Hubbard INSURER(S) AFFORDING COVERAGE NAIC i
INSURER A:AmerlCan States Ins Company 19704
INSURED Lomakatsi Restoration Project INSURER B: American States of Texas
PO Box 3084 INSURER C: SAIF Corporation
Ashland, OR 97520
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 LTR TYPE OF INSURANCE AUDI. SUB!, POLICY EFF POLICY EXP
POLICYNUMBER (MMIDOPrrYn MMIDD LIMITS
GENERAL LIABILITY EACH OCCURRENCE 1,000,00
A X COMMERCIAL GENERAL LIABILITY X 25CC1600447 04117/2013 0411712014 PREMISES (Eaoccurrence) $ 1,000,00
CLAIMS-MADE 1XI OCCUR MED EXP Any one person) $ 10,60
X OwnerlCont Prot. PERSONAL & ADV INJURY $ 1,000,00
X Loggers BFPD GENERAL AGGREGATE $ 2,000,00
GENL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 2,000,00
POLICY X PRO- LOC $
AUTOMOBILE LIABILT' COMBINED SINGLE LIMIT 1,000,00
(E.acadert$
B play AUTO 04CC2285274 04117/2013 04117/2014 BODILY INJURY(Per person) $
ALL OWNED SCHEDULED
AUTOS X AUTOS BODILY INJURY (Per accident) $
X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $
AUTOS Per accident
X UMBRELLAUAS X OCCUR EACH OCCURRENCE $ 2,000,00
A EXCESS LIAR CLAIMS-MADE 01SU3691439 0411712013 0411712014 AGGREGATE $ 2,000,00
DED X RETENTION $ 10,000 $
WORKERS COMPENSATION X WTORY CSTMTU- ER
AND EMPLOYERS' LIABILITY
C ANY PROPRIETORPARTNER/EXECUIVE YIN 992153 04101/2013 0410112014 EL EACH ACCIDENT $ 500,00
OFFICERMtEMBER EXCLUDED' F-1 N/A
(Mandatory in NH) E L DISEASE - EA EMPLOYEE $ 500,00
It yes, describe under
DESCRIPTION OF OPERATIONS below EL DISEASE - POLICY LIMIT $ 500,00
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AWch ACORD 101. Atltlldonal Remarks Schedule, IT more space Is required)
additional insured per policy endorsement CG7635(0207):
CERTIFICATE HOLDER CANCELLATION
CITYAS2 I
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 AUTHORIZED REPRESENTATIVE
R. Joe Hubbard
O 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD