HomeMy WebLinkAboutInsurance Certificate: Grayback Forestry Inc (2)
Ammo a CERTIFICATE OF LIABILITY INSURANCE °"'E""°°"Y""
1/10/2014
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: H the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsament. A statement on this certificate does riot confer rights to the
certificate holder In lieu of such endorsements .
PRODUCER
ME: Kendall Yeaw
Protectors Insurance, LLCM - I 842-2963 x
P.O. Box 4669 C N0
Medford OR 97504 ADDRESS:
INSURER(S) AFFORONO COVERAGE NAIC6
INSURERA:Arnerican States Ins Company 19704
INSURED GRAYBA INSURERS..
Grayback Forestry Inc WEARER c : I Indenmity Company
Western Emergency Services LLC INSURER D:
PO Box 836 - -
Medin OR 97532.0838 INSURER E:
. INSURER F:
COVERAGES CERTIFICATE NUMBER: &Q235840 REVISION NUMBER:
IS IS O CERTIFY POLICIES OF C LISTED ISSUED BELOW HAVE BEEN O THE RED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANYCONTRACT 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.
LTRR TYPE OF INSURANCE MR WVD POLICY NUMBER. PMLICYEF PMLI EXP LOINTB
GENERAL LIABILITY 1CI911182.50 112014 /12015 EACH OCCURRENCE 11000000
IVMMtHI:ULL IitNtHAL L1AtlILI1T _ PREMISES E000.UneMe $1.000,000
CLAMS-MADE IT-] OCCUR MEDEXP(Aaydnspemn) $10000
PERSONAL B ADV INJURY $1,000000
fFNFRM Aff.RFCATF $7nnn,(M
GEN'L AGGREGATE LIMIT APPLIES PER: 'PROWCTS - COMPIOP AGG $2000000
POLICY PR0. LOC $
1 -1 B AIROMOBL.E LAOLLr1Y 02CE228304-20 n2014 /12014 Eee 000 81,000,000
MAY AUTO BODILY IN.URY IPerpewp) $
ALL OVAED SCHEDULED BODILY INJURY IPerecadenll $
AUTOS NJTOS -PrF MIRED AUTOS AUTOS ED P ecad nl $
$
1A18RELLA LAB X' OCCUR OISW17057-50 112014 112015 EACH OCCURRENCE $2,OOg000
EXCESS LAO CLMMS-MADE AGGREGATE $2,000,000
MD nETENTION4 $
1YORKERSCOMPENSATION TVO$ S ALIR-
AN D EMPLOYERS' LABILITY YIN
ANY PROPRIETORIPATNEREXECUTIVE❑ NIA EL EACH ACCIDENT _
OMCER,MEMBPR EXCLUDED'!
(MAMMary In NNq. E.C. DISEASE-EA EMPLOYE $
11 ye9. OeYJlee=i.r
DESCRIPTION OF OPERATIONS balm E.L. DISEASE-POLICY LIMIT $
Excess Lieb®ry HA234609 1112014 n2015 Paq Lbnft $ 4,000,000
DESCISMM OF OPERATIONSN LOCATIONSN VETOCLES Aesch ACORD lM, AemaaM Psm s Sch*We, If Il o span is mR dr*Q
CER71FICATE HOLDER CANCELLATION
SHOULD ANY OF THE ADOVE DESCROSED FOLICIEe BD CANCELLED BEFORE
THE - EXPIRATION- DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS.
20 E Main St
Ashland OR 97520 A N oR ztaTleFmcoorr T Ys
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