HomeMy WebLinkAboutInsurance Certificate: Southern Oregon Transportation Engineering
SOUTH03 OF ID: SAW
CERTIFICATE OF LIABILITY INSURANCE 0 D 2vl/1 212vzol01YY)
a
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 endorsements .
PRODUCER CONTACT
Phone: 541.773-5358 NAME: Sheryl Wirts
Protectors Insurance, LLC Fax: 541-772-1906 PHONE 541-842-2968 FAx
Pilot Rock Ins Agency LLC (CA) AIC No Etl: ac No); 541-772-1906
PO Box 4669 VNREss: shreylw@protectorsins.com
Medford, OR 97501
Karol M. Igou INSURERS AFFORDING COVERAGE NAICC
INSURER A;CNAContinentaICasualty Co
INSURED Southern Oregon Transportation INSURERB: Valle Force Insurance Co
Engineering LLC INSURER C: American Casual Company
112 Monterey Dr
Medford, OR 97504 INSURER D:
NSURER E:
• INSURER F :
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 1
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 PODGY EFF POLICY EXP LIMBS J= wi LTR POLICY NUMBE0. MMIDD/YYYY MMIpOIYYYY
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,08
C COMMERCIAL GENERAL LIABILITY X X 64016108107 03115/2014 0311512015 PREMISES Ea eminence) $ 300,08
CLAIMS-MADE 51 OCCUR MED EXP(Myone person) $ 10,08
X Business Owners PERSONAL B ADV INJURY $
GENERAL AGGREGATE $ 2,000,00
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG $
POLICY PRO- LOC $
FFQ.T
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,00
Be accident) S
B X ANY AUTO X X B4018108110 03/1512014 03115/2015 BODILY INJURY (Per person) $
ALL OWNED SCHEDULED
AUTOS AUTOS BODILY INJURY (Per accident) $
NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS Per accident
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMSWADE AGGREGATE $
DELI RETENTIONS $
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS' LIABILITY YIN To" LIM T, ANY PROPRIETORIPARTNERIEXECUTIVE E.L. EACH ACCIDENT $
OFFICERIMEMBER EXCLUDED' NIA
(Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $
f tle3Cflhe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
A Professional Llab MCH288263850 03/22/2013 03122/2017 Occur. 1,000,00
Agg. 1,000,00
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ARach ACORD 101, Additional Remerlo Schedule, If more space Is required)
The City of Ashland S it's elected officials, officers, employees are
Additional Insureds:GENERAL LIABILITY-Waiver of Subrogation S Products
Completed Ops- SB300176BO108, Cancel per schedule SB147052 S SB174024C.
AUTO-Waiver of Subro-CA0440301 to Follow Cancel per G300660A Primary per
CA00010310
CERTIFICATE HOLDER CANCELLATION
CITYAS2
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
20 E Main Street
Ashland, OR 97520 AUTHORIZED REPRESENTATIVE
®1988.2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
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