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Home My WebLink AboutInsurance Certificate: Western Burner Company 263x60 A CERTIFICATE OF LIABILITY INSURANCE DAT1/zi/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: 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 Susan Rendsland NAME: Commercial Lines - 541-685-5300 PHONE FAX AMC No EX1: 541-685-5343 ac Ne:866-968-4807 Wells Fargo Insurance Services USA, Inc EMAIL ADDRESS: Susan.rendsland@wellsfar9o.com 975 Oak Street, Suite 900 INSURER(S) AFFORDING COVERAGE NAIC 0 Eugene, OR 97401 INSURER A : Houston Specialty Insurance Company 12936 INSURED INSURER B : Ohio Security Insurance Company 24082 Western Burner Company INSURER L 5851 Peace Lane INSURER D INSURER E Central Point, OR 97502 INSURER F: COVERAGES CERTIFICATE NUMBER: 7216543 REVISION NUMBER: 6HH EHORZ 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 TYPE OF INSURANCE IN DL 6UBR LTR POLICY NUMBER MMIDDIYYYY MMIDDMYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A TEN12349 3/2412013 3/24/2014 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES (Ea occurrence) $ 50,000 X $7,000 Deductible MEDEXP(Anyoneperson) $ 5,000 X Par OCCUrtenca PERSONALS ADV INJURY $ 1,000,000 GEN-L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- LOC PRODUCTS - COMPIOP AGO $ 2,000.000 JECT OTHER: S B AUTOMOBILE LIABILITY BAS1455002181 3/2412013 3/2412014 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY (Per parson) S ALL OWNED X SCHEDULED BODILY INJURY (Per ar<leent) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIREDAUTOS X AUTOS Per accident $ f UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DIED RETENTIONS $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY YIN STATUTE ER ANY PROPRIETOWPARTNERIEXECUTIVE ❑ NIA E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE EAEMPLOYEE S dyes. describe ender DESCRIPTION OF OPERATIONS W. E.L. DISEASE ~ POLICY LIMIT S DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe aHached N more space is required) Certificate Holder is an Additional Insured under General Liability per Form CG 2037 07104 attached. CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 East Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE 97s-4-/~ 7KH $&25' QDPH DOG ORJR DUH UHJLVWHUHG PDUNV RI $04`988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) I II111III I I IIII I III II 111111 I I1 111111111111111111111111111111ll ll111111l11111111