HomeMy WebLinkAboutInsurance Certificate: Lomakatsi Restoration Project (2)
at a i ► RECORDER
LOMAK-1 OF ID: KIY
ACORO°
CERTIFICATE OF LIABILITY INSURANCE DATE (MWDDNYYY)
10/16/2013
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(les) must be endorsed. H 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 Phone: 541-773-5358 NOME:, Kendall Yeaw
Protectors Insurance, LLC Fax: 541-772-1966 ac°NO a 547,-842-2963 c
Pilot Rock Ins Agency LLC (CA) No: 541-772-1906
'
PO Box 4669 ADDRESS: kehdall rotectorsins:com
Medford, OR 97501
R. Joe Hubbard INSURER(S) AFFORDING COVERAGE NAICi
INSURERA:American States Ins Com any 19704
INSURED LOmakatsi Restoration' Project INSURER B: American States of Texas
PO Box 3084 INSURER C: SAIF Cor Oration
Ashland, OR 97520 -
INSURERD:
NSURERE:
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 AUDI. =1
LTR TYPE OF INSURANCE POLICYNUMBER MMIDD MMIDD LIMITS INqR -GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00
A X COMMERCIAL GENERAL LIABILITY X 25CC16OD447 04/172013 0411712014 PREMISES Ea occurrence $ 1,000,00
CLAIMS-MADE ~ OCCUR WED EXP (Any one person) $ 10,00
X Owner/COnt Prot. PERSONAL B ADV INJURY $ 1,000,00
X Loggers BFPD - GENERAL AGGREGATE 2,000,00
GEM AGGREGATE LIMIT APPLIES PER PRODUCTS -COMPIOP AGO $ 2,000,00
PoLICV X 'MCT F-] LOC $
17 AUTOMOBILE LIABILITY OMBBI ED SINGLE LIMIT $ 1,000,00
B ANY AUTO 04CC2285274 0411712013 04117/2014 BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accitlent) $
Ix AUTOS ON OWNED PR RW DAMAGE $
X HIREDAUTOS AUTOS Per accident
$
X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 2,000,00
A EXCESS LIAR CLAIMS-MADE 01SU3691439 _ 0411712013 04/172014 AGGREGATE. It 2,000,00
OED X RETENTION 10,005 $
WORKERS COMPENSATION X WC STATLL OlR
AND EMPLOYERTUMILTTY TRY LIMBS ER
NIA 992153 04101/2013 04/0112014 E.L. EACH ACCIDENT $ 500,000
C ANY PROPRETORPARTNER/ CUiNE YIN
OFFICERRAEMBER E(CLUDED9
(Mandatory In NH) E.L. DISEASE-EA EMPLOYEE $ 500,000
DESCRIPTION OF dOPERATIONS below E.L. DISEASE- POLICY LIMIT $ 500,00
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Am ich ACORD 101, Additional Remarks Schedule, If mom space Is required)
additional insured per policy endorsement CG7635(0207):
I
CERTIFICATE HOLDER 'CANCELLATION
CITYAS2
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1
THE EXPIRATION DATE THEREOF, City of Ashland ACCORDANCE WITHTTHEPOLICYPROVISIONSCE WILL BE DELIVERED IN
26 E Main Street
Ashland, OR 97520 AUTHORIZED REPRESENTATIVE
R. Joe Hubbard
0.1988-2010 ACOHD CORPORATION. All rights reserved. I
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD li