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HomeMy WebLinkAboutInsurance Certificate: DBA Economic & Financial RAY1037 OP ID: TAAM UAT ,~acoRO° CERTIFICATE OF LIABILITY INSURANCE 02106114 oz/osna 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 Liberty Mutual Insurance PHONE FAX NAME: PO BOX 1$$065 A/C No EMI, A/c No: Fairfield, OH 45018 E-MAIL Fullerton & Company Inc ADDRESS: INSURER(S) AFFORDING COVERAGE NAICa INSURER A: American Economy 19690 INSURED Raymond Bartlett INSURER B: DBA Economic & Financial Analysis INSURER C : 1409 Franklin St Ste 201 INSURER D: Vancouver, WA 98660 INSURER E: INSURER F: 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. INSR POLICY EFF POLICY EXP NYYYI LTR TYPE OF INSURANCE POLICY NUMBER MM/DD MMIDD LIMITS GENERALLIABIUTY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X 02BP29475200 12/28/13 1212$114 PREMISES Eaoccurrence S 1,000,00 CLAIMS-MADE FRIOCCUR MED EXP(Any one Person) It 10,00 X Business Owners PERSONAL 8 ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 2,000,00 POLICY PRO X LOC $ "CT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS H AUTOS BODILY INJURY (Per accident) E NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident E UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY YIN TORY LIMIT ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E. L. DISEASE - EA EMPLOYE E M yes, describe under DESCRIPTION OF OPERATIONS belay E.L. DISEASE-POLICY LIMIT E DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) City of Ashland is listed as Additional Insured by written contract, agreement, permit or schedule. CERTIFICATE HOLDER CANCELLATION CITASH3 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. Public Works Department 20 East Main Street AUTHORIZED REPRESENTATIVE Ashland, OR 97520{~yy~ I ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 4AW AXIS Insurance Company 303 W. Madison, Suite 500, Chicago, Illinois 60606 866-259-5435 AXIS PRO MPL SOLUTIONS DECLARATIONS PAGE THIS IS A CLAIMS MADE POLICY. CLAIM EXPENSE IS INCLUDED IN THE LIMIT OF INSURANCE AND RETENTION. THE LIMIT OF LIABILITY AVAILABLE TO PAY DAMAGES SHALL BE REDUCED AND MAY BE TOTALLY EXHAUSTED BY AMOUNTS INCURRED AS CLAIM EXPENSE. PLEASE READ THE ENTIRE POLICY CAREFULLY. POLICYNO.: MCN000079741301 RENEWAL OF. MCN000079741201 IN RETURN FOR THE PAYMENT OF THE PREMIUM, THE COMPANY AGREES WITH THE INSURED TO PROVIDE INSURANCE UNDER THE PROVISIONS IN THIS POLICY. Item 1. Named Insured and Mailing Address: Raymond J. Bartlett dba Economic & Financial Analysis 1409 Franklin Street, Suite 201 Vancouver, WA 98660 Item 2. Policy Period: From: October 28. 2013 To: October 28. 2014 12:01 A.M. standard time at the address of the Named Insured as shown above. Item 3. Retroactive Date: October 28. 2010 IF NO DATE IS STATED HERE, COVERAGE DOES NOT APPLY TO WRONGFUL ACTS COMMITTED PRIOR TO THE INCEPTION DATE STATED IN ITEM 2. ABOVE. Item 4. Schedule of Insured Services: Consulting services including economic and financial forecasting services for others Item 5. Limit of Insurance: a. $ 1,000,000 Each Wrongful Act b. $ 1,000,000 Total Limit of Insurance Item 6. Retention: $ 5,000 Each Wrongful Act Item 7. Premium: $ 1,539.00 State Surcharge/Tax: $ 0.00 Item 8. Endorsements and other forms attached to this policy: AXIS PRO MPL Solutions - MPL 1100 (11-09) 1. Consultants Change Endorsement - MPL-71 (11-09) 2. Extended Reporting Period Option Endorsement - MPL-112 (11-09) 3. Washington Change Endorsement - MPLWA-01 (03-10) MPL 1110 (11-09) Page 1 of 2 02999 "IS Specialty U.S. Services, Inc. All Righft Reserved. All notices and inquiries should be addressed to: AXIS PRO a business unit of the Professional Lines Division of AXIS Insurance X)WU~,' ' II,~Q(y,- 1201 Walnut, Suite 1800 V Kansas City, Missouri 64106 Authorized Representative Issued On: October 1. 2013 MPL 1110 (11-09) Page 2 of 2 02009 AXIS Specialty U.S. Servlces, Inc. All Rights Reserved. PEMCO 325 Eastlake Avenue East PEMCO Umbrella Policy PO Box 778 Insurance Seattle, WA 98111-0778 Renewal Declarations PEMCO Mutual Insurance Company Policy Number IJMB 1240459 = a smcc u'a " . FFPECi1VE GATE sr +'f`E%PI I 31A '1 + r++'(Zl 6r ry le.valuad C-- - `rOZy1A/20x3 ~;07/dR ;l.._Q~'t4° h+s4~-w>r 4 n iij:~ { - F, Named Insureds: Thank you for choosing PEMCO. RAYMOND JOHN BARTLETT PENNY KAY BARTLETT 805 NW 142ND 5T VANCOUVER WA 98685-1394 Please verify all information. If there are changes, Please call our office. IE#CIUIRERiMI~t%MEIIVI~PO~I,LMITS;,OF~tINDERLYINGMINSURANCE r o~ Your PEMCO Umbrella Policy provides coverage over and above the required minimum policy limits of underlying insurance shown below. If underlying insurance is not maintained with the minimum limits as shown below, you'll have a gap in coverage. That means you would be unprotected for any difference between the amount of coverage you have and the required minimum limits shown. Auto Liability Bodily Injury $250,000 each person/$500,000 each occurrence Property Damage $100,000 each occurrence Home Personal Liability $300,000 each occurrence Watercraft Liability $300,000 each occurrence Personal Watercraft $300,000 each occurrence Motorcycle Liability Bodily Injury $250,000 each person/$500,000 each occurrence Property Damage $100,000 or Combined Single Limit $300,000 Other $300,000 AUTO POLICY INFORMATION Note: Umbrella Liability Coverage is not extended to stored vehicles on on underlying auto policy. Policy number or carrier CA 1010634 Liability limits Bodily Injury limits $250,000 each person/$500,000 each occurrence Property Damage limits $100,000 Covered drivers Date of birth Raymond John Bartlett auestions4 Check our Customer Care site at pemco.com, or call 1.800-GO-PEMCO (1.600.467.3626). Umbrella Declarations 12/11 13671.001 Rev. 12/2011 Page 1 of 3 PEMCO 325 Eastlake Avenue East PEMCO Auto Policy PO Box 778 Insurance Seattle, WA 98111-0778 Amended Declarations PEMCO Mutual Insurance Company Policy Number CA 1010634 Tr v r.. Vo ued Cwslcma# Smce &1,8,11, 1VF~ i ON 21 NIZ, t . 'i!T/I IIeY "s t„- 10 a„y °7aF~,- sr x' 12.01 A:I.1r P AND F..1E 3 r 'n .3 =*ec~ `~.-e ~t Named Insureds: This new Declaration includes recent changes you requested to your policy or updated information we've received. It PENNY KAY BARTLETT replaces any earlier version. Please keep it with your policy. RAYMOND JOHN BARTLETT 805 NW 142ND ST VANCOUVER WA 98685-1394 Expired driver activity. Endorsement effective date: 12/08/13 Please verify all information. If there are changes, please call our office. YOUR VEHICLES 2005 VOLVO S60 2.5T FWD VIN YV I RS592952425533 COVERAGES Limits/Deductible Premium f A' '~:°~.5250'000~ ack rson/ 300;000~ea"ch o~" c uc An7wn Props Damage 4abThty $100 000 each occurrence $80 22 ~112dersu~1~1'o„tonstlBodlT.lrlnlv_ry'"y'~-:'';x$250 OOOlfl"=~pC,'hhuperson""z/$SQO 000 eackbccvrrence;~",;,"+5'G,..t;; '~$6294 Undennsured Motonst Property Damage $100 000 each occurrence $5.75 3P~na. ryury Pfotedlo~ta'~.~~-$35000 ~~~~:c~ra r a~ k`.m~" s~~z'~S7r2:.$.Z~ Loss of Income $700 max per week/$36,400 max per occurrence each person Included Comprehensive _ Deduch ble: 5300 $51.33 G'Auto rq/Leo~~T at . t' P;ti =No'Covere 'r ",,s".,'~ w. = "'--'~S , :'~-.r r~_,• y s r+ t3r..i. .-....ae. m- ~,r ~e`•-fl«'Y4r5~*.~ .it.Y...~..a..w~!.~.'~`~'o~~..r " u:~._ ; , Towing $100 $9.43 ............„RentaGReimbursemer'9~,,, Stereo/Communication Equipment No Coverage u7u< d~Egpimenl'1c'°`r...w,~.'~ ~Y No~Covera9`e,i- War~r.'#ffix IIrS s'rra,~ AI Vehicle Premium $623.09 2011 BMW 328X1 VIN WBAUU3C50BA541669 COVERAGES Limits/Deductible Premium Bodily Injury $250,000 each person/$500,000 each occurrence _ $137.69 +,roP#aPaAy~Domagp.4aliilJY,~~`~.~'.B~y.. r .i$100`O4SQ,9ac.IT„or`.cu rBRcenr.-.., 1. ~`~1'~ ~.w ic'!u.2 ,.,#...64'„td3 Underinsured Motorist Bodily Injury $250,000 each person/$500 000 each occurrence $62.66 Underinwrad M`6 tonu Pro Da , _P @Thti ...Spg_ t__ _ r.-?~,..,.'".....'"w.~9•e,` $5x52'8 Personal Injury Protection $35,000 $58.24 L"assoElrtcomP°kyr r''ru $ r EL.E_._.9e1/$_ 70B 'y9,'$ m r er w 36-400 max. peoccurrexeeachr~ersM alit ~LrM"Li~ricluded,e Collision Deductible $500 $228.12 Auto loan/Lease No Coverage uwr Trnvirig'-}`; 's'rNi°w;~ tvtiiY-''>rk^':No~Covmage,' Rental Reimbursement No Coverage '.Cu,st ,Gojt+mul!iLa,MOn Equipment ~ No Cayedage. , - S>' c~ ,.t~'< .s "1 a I y Customized Equipment No Coverage _ Vehicle Premium $627.87 2008 BMW 5281 VIN WBANU53578CT12970 COVERAGES Limits/Deductible Premium ~$250,000 egch,pe son/3500 000 each gccurrenceme nq ,T~'; j$146',9,Q A list of your discounts is shown on the next page. Questions? Check our Customer Caro site at pemco.com, or call 1-800-GO-PEMCO (1-800-467-3676). Auto Declarations 08/10 Page 1 d 3 COVERAGES (continued) Limits/Deductible Premium party eoch occurrence $68.73 Pro Damage Lla i iy 100 000 ~~,Undeaiisuied'Mo nos` fy~t(rju t' `$250000 each person/5500;000~,'eacilioccur"" rence` M.41 Underinsured Motorist Property Da ma a $100,000 each occurrence $5.81 Lltrv'jv 621113 Persond-In u Protection ~ $35 000 - Loss of Income $700 max per week/$36 400 max per occurrence each person Included Comprehensive Deductible: $300 $68.93 Rents{iReimbursemarit,.,,,,~~,,.z.~'~rr~r~'d~N.o Coo-~verageL~~~y,.t!~„s 3,`1~ R_ qe,~._• Stereo/Communication Equipment No Coverage ffiCustomiied(Equrpment t. "krb,„.e ~tt~ga, oC' vercge, i!/„sr5 kr#•` 1~+.'-,t° _ . _t_... Vehicle Premium $619.76 Premium change amount -$87.29 Your total annual premium' $1,900.72 "Includes $30 Base Policy Premium YOUR DISCOUNTS Anti-Theft Auto Plus Homeowner Educator Low Mileage Multiple Car Safe Driver HOUSEHOLD DRIVERS Raymond John Bartlett Safe driver years: 8 You earned a Safe Driver year For the previous polity period. Driver's discounts: Safe Driver Penny Kay Bartlett Safe driver years: 8 You earned a Safe Driver year for the previous policy period. Driver's discounts: Safe Driver Alexander M. Bartlett Safe driver years: 7 You earned a Safe Driver year for the previous policy period. Driver's discounts: Safe Driver POLICY FORMS AND ENDORSEMENTS Edition Form date Endorsement Vehicle 14-148 01/11 Amendatory Endorsement - Policy and Transaction Fees All 14-95 07/94 Auto Policy Contract All PAE-58 12/83 Loss Payable Endorsement 2008 BMW 5281 All existing endorsements and exclusions remain in effect. Representative: PEMCO Customer Service, 1-800,GO.PEMCO 11-800-467-3626) Executive: Steve Miller, VP and Chief Operating Officer Questions? Check our Customer Caro site at pemcacom, or call 1-800-GO-PEMCO (1-800-467.3616). Auto Declarations 08/10 Pcga2o 3 K o o t 7 a °~`o W U > O N t~ u .o,o zoaty ,icf..~ N G •C OW C R M N u { 5$°_ v 'mow Jw I 3` ~y 7Htnt0 'O ebE of N a U f0 s 9 70 > ;E oZrCD s Z 4'Uf m o u 0 Z o Q' a>, 0 C T HZ O. w 4. Y Y .c. Q : v ar 4) 0 .o E 3 R J 3 ` wcy~So ° c a:wY v i v .Dw o~ Z (y ,c u 'a~ C w O r t~ y E c~ i•- t.! 4 W Ld 2: LL ?'E o n e `o y v o ; y i -Z 0 cluQc., 0 v rZr,u Tw O, v~°rn o > ° ~oGZ VG W + p C M O TL R1 yV) U U i0 w bA O C C 'E 4 ' y u ! } 9 u Y~ FFFW .y. u ~ D N ~ L ` a ~ ( 0 rW^ y ~y J W 1 I o y 4i-G s~` o ~ H !l7 tC o o e y a° V h 4U~7~ wee w Y ~ ~7 H~ yT f~l A c~ w 4 m o to ham) a°~ ` +y ayi w c~ !n > Y " e 2 u Y o a ' u4 .u Ch v) 3 3 c~ H l> a LL EK.~a zmU PEMCO 325 Eastlake Avenue East PEMCO Auto Policy PO Box 778 Insurance Seattle, WA 98111-0778 Amended Declarations PEMCO Mutual Insurance Company Policy Number CA 1010634 EFFECTIVE DATE 's EXPIRATION DATE > T z' Valued,Cu3tomer Smce p ^r i - - 07/y73/13 07/83~/p14 I _1 "+."12.01 A.M PACIFlC STANDARD TIME Named Insureds: This new Declaration includes recent changes you requested to your policy or updated information we've received. It PENNY KAY BARTLETT replaces any earlier version. Please keep it with your policy. RAYMOND JOHN BARTLETT 805 NW 142ND ST VANCOUVER WA 98685.1394 Endorsement effective date: 02/10/14 Please verify all information. If there are changes, please call our office. YOUR VEHICLES 2005 VOLVO S60 2.57 FWD VIN YVI RS592952425533 COVERAGES Limits/Deductible Premium Bodilyglnjury„ ;..`-ter„ ;..~yyay;;~:;~,`i,.,~`~,,,w,m_$25_0'000each pe''fson/$500 OOOeooh~occurrerice ` x,45' Property Damage Liability $100,000 each occurrence $80.22 .Underins'°'~_ur'FedLMotonsFBodlly ~njpry' ,-r•; $250000each,per5o^/$500 000'each «currence :_'T _ ,-.."~i $6522 Underinsured Motorist Property Damage $100,000 each occurrence m $5.75 Pers°o"`nal lnu Troteon _.___....w.,... Loss of Income $700 max per week/$36,400 max per occurrence each person Included (Collision • ? Deduchble„$500:::', _.w . ~.~_.:.~_W.._,.,;:1 $Lv1>a0 Comprehensive _ Deductible: $300 $51.33 Auto Loan/Lease o Coverage - Towing $100 $9.43 Rental_ IReimbursemenf,.____'.~v,,,-,,,n EE___.___;_~.w„,,..,,. 4,d Stereo/Communication Equipment No Coverage Cuslomized3Eq_ipmerit - No Cover6g= Vehicle Premium $623.09 2011 BMW 328X1 VIN WBAUU3C50BA541669 COVERAGES Limits/Deductible Premium Bodily Injury $250,000 each person/$500 000 each occurrence $137.69 Properly Damage7Liabihty s ::$100;000'each occurerce x.,u ' $6v4?~A3~ Underinsured Motorist Bodily Injury $250,000 each person/$500 000 each occurrence _ $62.66 lnderinsuredl Motonst((Property_Damage $100 000 each occurrence 'F 4__ _ 41_ q $5K52 Personal Injury Protection $35,000 $58.24 ,moss of?Income :_$700 maxper week/$36,400 ma>i:'p_e i occurrence:each perspn:zLL; Includid Collision u Deductible: $500 $228.12 Wu~ FComprefiensve N''_,--. Auto Loan/Lease _ No Coverage _ To__._.` -No Rental Reimbursement No Coverage _ 71 Stereo Eommunication E m ment"s"rv- No Covera e .,:h- : z Customized Equipment No Coverage Vehicle Premium $627.87 2008 BMW 5281 VIN WBANU53578CT12970 COVERAGES Limits/Deductible Premium Badily]rijury 250,000'edchperson/$500000each~ currence I "e $7731,8;`; A list of your discounts is shown on the next page. Questions? Check our Customer Care site at pemco.com, or call 1.800-GO-PEMCO (1-800-467.3626). Auto Declarations 08/10 Page I of 3 COVERAGES (continued) limits/Deductible Premium Property Damage Liability $100,000 each occurrence _ $81.03 Undeiirisured MotorisLBodilylnjury~v_ $250 OOO.each person/$500 OOO:each,occurrence_ T 1 - x$65 95 Underinsured Motorist Property Damage $100,000 each occurrence $5.81 77 Person aqI njury Protection Loss of Income $700 max per week/$36,400 max per occurrence each person Included Comprehensive Deductible: $300 $80.78 Towing No Coverage __~a.,. RentofReimbursement~ IJo C6verogen '1 Stereo/Communication Equipment No Coverage CusfomiYed'Equipment~T-~~ No Covera -i- ge Td Vehicle Premium $715.94 Premium change amount $40.30 Your total annual premium' $1,996.90 'Includes $30 Base Policy Premium YOUR DISCOUNTS Anti-Theft Auto Plus Homeowner Educator Low Mileage Multiple Car Safe Driver HOUSEHOLD DRIVERS Raymond John Bartlett Safe driver years: 8 You earned a Safe Driver year for the previous policy period. Driver's discounts: Safe Driver Penny Kay Bartlett Safe driver years: 8 You earned a Safe Driver year for the previous policy period. Driver's discounts: Safe Driver Alexander M. Bartlett Safe driver years: 7 You earned a Safe Driver year for the previous policy period. Driver's discounts: Safe Driver POLICY FORMS AND ENDORSEMENTS Edition Form date Endorsement Vehicle 14-148 01/11 Amendatory Endorsement- Policy and Transaction Fees All 14-95 07194 Auto Policy Contract All PAE-58 12/83 Loss Payable Endorsement 2008 BMW 5281 All existing endorsements and exclusions remain in effect. Representative: PEMCO Customer Service, 1-800-GO-PEMCO (1-800,467-3626) Executive: Steve Miller, VP and Chief Operating Officer Questions? Check our Customer Care site at pemco.com, or call 1.800-GO-PEMCO (1.800.467.3626). Auto Declarations 08/10 Page 2 of 3 PEMCO 325 Eastlake Avenue East PEMCO Auto Policy PO Box 778 Insurance Seattle, WA 98111-0778 Amended Declarations PEMCO Mutual Insurance Company Policy Number CA 1010634 OTHER INTERESTS Loss Payee, 2008 BMW 5281, Loan Number - Not Available BMW Financial Services, PO Box 650700, Hunt Valley, MD 21065-0700 Questions? Check our Customer Care site at pemco.com, or call 1-800-GO-PEMCO (1-800-467-3626). Auto Declarations 08/10 Page 3 of 3