HomeMy WebLinkAboutInsurance Certificate: Soda Mountain Broadcasting
``~RO® CERTIFICATE OF LIABILITY INSURANCE DATE(.MIDDNI
1 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 pollcy(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 CONTACT
Commercial Lines - 541-685-5300 NAME:
PHONE I -FAX Wells Fargo Insurance Services USA, Inc E-MAIL
PEk)) (AEG, No):
ADDRESS:
975 Oak Street, Suite 900 - -
INSURERLS) AFFORDING COVERAGE NAIL #
Eugene OR 97401
INSURER A: National Surety rety Corporation
l 21881
INSURED
Soda Mountain Broadcasting, Inc. DBA: KDRV 8 KDKF INSURER B
INSURER
C/O PO Box 7009 C!
-
INSURER D:
INSURER E :
Eugene OR 97401
INSURER F: -
COVERAGES CERTIFICATE NUMBER: 6922789 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 01'HER 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.
_ .AOOL
LTR TYPE OF INSURANCE y POLICY NUMBER POLICY EFF I POLICY E%P
SUER IC MIDD/YYYY
M
MMIDDIYYYY LIMITS
GENERAL LIABILITY
A MZX80952552 1211/2013 12/1/2014 EACH OCCURRENCE i5 1,000.000
COMMERCIAL GENERAL LIABI L"Y DAMAGE TO RENTED
r-" PREMISES IE Pc„unencet S 100000
CLAIMS-MADE X OCCUR MED EXP (Any one person) I S 5.000
PERSONAL 840V INJURY g 1000000
;GENERAL AGGREGATE g --2.000,000
GEN'L AGGREGATE LIMIT APPLIES PER
I ~ -
- - - 1
POLICY PRO LOC :PRODUCTS COMPIOPqGG
: 5 .2.,0-00 00.0
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT i
i.lgd accidenq_ _ is
ANY AUTO i BODILY INJURY IPe Persunl 5 - - - -
ALL OWNED L.._I SCHEDULED I I _ _
AUTOS AUTOS BODILY INJURY IPe a c,denl S
HIRED AUTOS I IN NOWNED -
1 AUTOS PROPERTY DAMAGE
I [Per acudenl) 5
j IS
UMBRELLA LIAR OCCUR !
f-"_ I EACHO_C_CU_RRENCE S
CLAIMS -MADEI - - -
EXCESS LIAR AGGREGATE
I S
r
DED i RETENTION 5 I I $
WORKERS COMPENSATION WCSTATU
AND EMPLOYERS' LIABILITY IOTH-I
ANY PROPRIETORIPARTNERIE%ECUTIVE Y I N I 1 TORY LIMITS. I . E R
O F F I C E R I M E M B E R EXCLUDED? ❑ I N I A E L EACH ACCIDENT 1 S
(Mandatory in NH)
It yes. describe under I , I E L DISEASE - EA EMPLOYEEI-$
DESCRIPTION OF OPERATIONS below I -
E L DISEASE POLICY LIMIT
)
I I
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Anach ACORD 101, Additional Remarks Schedule, It more space is re0ulred)
Certificate holder is added as additional insured.
CERTIFICATE HOLDER CANCELLATION
Ashland Fiber Network City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
20 East Naub THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Ashland, OR 97520 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
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ACORD
ACORD 25 (2010/05)
-201 The ACORDnamelllillll llllllllilllllLIIIIIIIIIIIIIIIIIII VIIIIIII 11111 11111 11119881 11111 11111 1111ACORD 111111111 CORPORATIONti All rights reserved.