HomeMy WebLinkAboutInsurance Certificate: TJ Smith Trucking
OATE(MWOONYY I
ACOR - CERTIFICATE OF LIABILITY INSURANCE 12/5/201 Y 3
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Paul W VOlz Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
450 Siskiyou Blvd Ste 5 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Ashland OR 97520
541-482-8463 INSURERS AFFORDING COVERAGE NAICM
INSURED TERRANCE J. SMITH REG #118957 INSURERA FARMERS INSURANCE EXCHANGE
DBA: T.J. SMITH TRUCKING INSURER B: FIRST FINANCIAL INSURANCE CONPANY
PO BOX 1045 INSURER C:
PHOENIX, OR 97535 INSURER 0:
PH: 541-535-6063 INSURER E:
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR DL POLICYEFFECTNE POLICY EXPIRATION
LTR NZRD TYPE F INSURANCE POLICY NUMBER DATE MM/DONY DATE MWDDNY LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1-10-0-010-0-0
COMMERCIAL GENERAL LIABILITY PREMISES Ea ox Ire $ 100,000
CLAIMSMADE O OCCUR MED EXP(Anyoneperson) $ 5,000
B 109FROOIIS 11-21-2013 11-21-2014 PERSONAL B ADV INJURY $ 1,000.000
GENERAL AGGREGATE $ 1,000,000
GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000
X POLICY jEo- LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
ANYAUTO (Ea amiden0 $ 1,000,000
ALLOWNEDAUTOS _ BODILY INJURY
X SCHEDULED AUTOS (Per person) $
A HIRED AUTOS 03490-48-77 11-01-2013 11-01-2014 BODILYINJURY
NON-OWNEDAUTOS (Peracddm)
- PROPERTY DAMAGE $
(Peraociden0
GARAGE LIABILITY AUTO ONLY-EAACCIDENT $
ANYAUTO OTHER THAN EAACC $
AUTOONLY: AGO $
EXCESSIUMBRELIA LIABILITY EACH OCCURRENCE $
OCCUR C CLAIMSMADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ Is
STATU- H-
WORKERS COMPENSATION AND TORYLIMITS ER
EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIVE E.L. EACH ACCIDENT $
OFFICER/ BER E CLUDEDI E.L. DISEASE - EA EMPLOYE $
Ifyes, describe under
SP ECIAL PROVISIONS W1. E.L. DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
TRUCKING INCLUDING ROCK HAULING, DESCRIPTION WAIVED
I CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of AShl FF:77~ DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL_ DAYS WRITTEN ,
20 E' Main S NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Ashland, OR IMPOSE NO OBLIGATION OR LIABILITY OF ANV KIND UPON THE INSURER, ITS AGENTS OR
DEC - G 2013 REPRESENT N S.
AUT ORIZ R RESEN ATN
J _ I I I
ACORD25(2001/08) CACORD CORPORATION 1988