HomeMy WebLinkAboutInsurance Certificate: Bleser Construction
DENNJBL-01 KORNELLT
CERTIFICATE OF LIABILITY INSURANCE 2/12/2 DAT/121201DIY4
4
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 j
1-the-terms-:and condltions'of the'policy ,-certain 'policies may require an endorsement. -A statement on this certiFledte does•not confer rights to the
certifrcate.holderIn. lieu of such endorsement(s)-{ I
(PRODUCER L .i f I CONTACT I O {r. ' '
ASSUfety NW~.InC 1._ - 5^ HE NE I 503 777-3700 F < I
89311 SE Foster Rd S 200 ' I No Eat:( ) An: xa:
Portland, OR 97266---- - - I a T, VOA,;"
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC p
INSURER A: Nevada Capital Insurance Company; 11165
INSURED INSURER B :
Dennis J. Bleser dba Bleser Construction INSURER C:
707 Stringer Gap Road INSURER D:
Grants Pass, OR 97527
INSURER E
INSURERF: '
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
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.
ILTR TYPE OF INSURANCE POUCYNUMBER MMMD EFF MPOUCYEXP
MIDD/YYYY UNITS
A X COMMERCIALGENERALUABIUTY EACH OCCURRENCE S 1,000,000
CLAIMS-MADE OCCUR 77NPP4003419 - 0211312014 02/1312015 PREMISES Ea o=nence E 100,00
MEO EXP (AnY'one Person) E ''Sr00
L-. _ PERSONAL B ADV INJURY $ 1,000,00
GEN'L AGGREGATE LIMIT APPLIES PER f t I_ F - GENERAL AGGREGATE' $ 2,000,000
X'POLICY Ej jEo--LOC PRODUCTS-COMP/OP AGO S 2,000,00
I OTHER: : E
- - - LE LIMIT - -
( ( AUTOMOBILE LIABILITY (Ea COMBINED IN $
"
r MANY AUTO.. BODILY INJURY (Par person) $ • ALLOMED SCHEDULED BODILY INJURY (Par a nt) S
AUTOS' AUTOS
NON
HIRED AUTOS AUTOS ED Pere ,oft $
S
UMBRELLA UAB OCCUR EACH OCCURRENCE S
EXCESS UAB CLAIMS-MADE AGGREGATE $
DED RETENTIONS E
PER TH-
WORKERS COMPENSATION
ANDEMPLOYERS! LIABILITY YIN STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
❑NIA
OFFICERAEMBER EXCLUDED?
(Mandatory In NH) - - E.L. DISEASE - EA EMPLOYE E - If r36 dmimoe under
DRIPTION OF OPERATIONS bebw E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AddlUonal Remarlu Sexadule, may W anaeNad If mom apace Is myulrad)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION ATE THEREOF, NO
CCORDANCE WITH THE POLICY PROVISIONSCE WILL BE DELIVERED IN
City of Ashland A
20 East Main Street
Ashland, OR 97520
AUUTHLOVR ZEED REPRESENTATIVE
01988.2014 ACORD CORPORATION. All rights reserved.
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