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HomeMy WebLinkAboutInsurance Certificate: Pump Pipe & Tank PUMPP-1 OP ID: B3 CERTIFICATE OF LIABILITY INSURANCE 1 DATE 1 10131 /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(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 endorsements . PRODUCER .-*v 817-640-5035 CONTACT 'n,,i NAME:. Monroe&Monroelnsp urance~ • 817-640-0131 PHONE FAR Agency, Ltd.. (.~No Ext: V" No: 2921 Galleria Dr., Suite 102 E-MAIL ' Arlington, TX 76011 ADDRESS: Jim Beam, CIC INSURERS AFFORDING COVERAGE NAIL R INSURER A: Mid-ContinentCasualtCo. 23418 INSURED Pump Pipe & Tank Services LLC INSURER B: Bob McHenry dba Pump Pipe & Tank Services INSURER C Petroleum Pump Supply INSURER D: Box 146 Talent, OR 97540 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 I ADD TYPE OF INSURANCE BR POLICY NUMBER MMIDDYIYYEFF YY MMIDDY EXP LTR IYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,06 A X COMMERCIALGENERALLIABILITY 04GL889507 11115/13 11/15/14 PREMISES Ea occurrence $ 166,60 CLAIMS-MADE a OCCUR MED EXP (Any one person) It X' Pollution Liab PERSONAL B ADV INJURY $ 1,000,00 P-X Professional Liab GENERAL AGGREGATE $ 3,000,00 PRODUCTS - COMPlOP AGG GENE AGGREGATE LIMIT APPLIES PER: It 3,000,00 PRO... - - . _ . _ _ _ ;POLICY 'X.. FLOC. "a , $ AUTOMOBILE LIABILITY ,:..f COMBINED SINGLE LIMIT_ t - M - Ea accitlent ANY AUTO" r ..t ..1.._ BODILYINJURY.(Pecperson).=$ ALLOWNED, - SCHEDULED•., BODILY INJURY (Per accident) AUTOS"' AUTOS _ 7 " H NONOWNED Per UPamid ER enl AMAGE $ HIREDAUTOS AUTOS $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WCSTATU- OTH- AND EMPLOYERS' LIABILITY YIN IA E _ ANY PROPRIETORIPARTNERIEXECUTNE E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? NIA (Mandatory In NH) E.L. DISEASE -EA EMPLOYEE E If yes. describe under _ DESCRIPTION OF OPERATIONS belmv l E.L. DISEASE-POLICY LIMIT $ A Equipment Floater 753599 11/15/13 11/15/14 Owned Equ 4,90 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) CERTIFICATE HOLDER CANCELLATION CASHLAN 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 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD