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HomeMy WebLinkAboutInsurance Certificate: Grayback Forestry Inc PATE rcrrr) AC40 CERTIFICATE OF LIABILITY INSURANCE 12/18122013 lllw~ 013 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 endorsement(s). PRODUCER CONTACT NAME: KPD Insurance, Inc. PHONE FAx PO BOX 784 E.ti-541-741-0550 AIL No : 541-741-1674 MAIL Springfield OR 97477 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURER A:SAIE Corporation 36196 INSURED GRAY03W INSURER B:Zurich BTLCan Insuranre Co Grayback Forestry, Inc. INSURER C PO Box 838 Merlin OR 97532 INSURERD: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 248604288 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES F 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. ILTR TYPE OF INSURANCE OINSR X SUBR POLICY EFF VAID POLICY NUMBER MMODNWY MMMDYNYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ ( RENTED TO - COMMERCIAL GENERAL LIABILITY DAMAGES PREMISES Ea occurrence) $ CLAIMS-MADE OCCUR MEDEXP(Anyoneperson) $ PERSONAL &ADV INJURY $ GENERALAGGREGATE $ GEN-L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ POLICY PRO- LOC $ JFCT AUTOMOBILE LIABILITY Ea acadent ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY Peracoden0 $ AUTOS AUTOS N01-011ED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Peramdenl UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS $ A WORKERS COMPENSATION 95606 /112014 /1/2015 X WC STATU. DTH- TORY. A AND EMPLOYERS' LIABILITY YIN 63584 1/1/2014 11/2015 IMITR B OANY FFICEOPRIETERZEXCLUDEp ECUTIVEā‘ NIA C-9663291 (MUM State) 1112014 /1/2015 E.L. EACH ACCIDENT $500,000 (Mandatory In NH) E.L. DISEASE - EA EMPLOYE $500,000 If yos descrwa roar _ DYSCRIPTION OFOPERATIONS below E.L. DISEASE - POLICY LIMIT $500.000 Workers Compensation and Employers Liablity Limits DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace Is required) Re: All Operations CERTIFICATE HOLDER CANCELLATION 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 East 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