Loading...
HomeMy WebLinkAboutInsurance Certificate: Evergreen Job & Safety OP ID: 7L CERTIFICATE OF LIABILITY INSURANCE 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,certificale 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 :ceAificate:goes. not confer rights to the _ certificate holder in lieu of such endorsements . PROOUCER..._._ CONTACT 1 202-263-4000..; . NAME' Hays Affinity Solutions 202-263-4001 PHONE FAX Suite 425 West EWAIL , 1025 Thomas Jefferson St NW PRAPD ODUCER ( lprEVERG-2 r ER Washington, DC 20007 -8te7 INSURERS AFFORDING COVERAGE NAIC C INSURED Evergreen Job & Safety INSURER A:Lloyds of London Training, Inc. ' INSURER B: Jesse Langslet INSURER C: 328 Ironwood Circle Roseville, CA 95678 INSURER D: INSURER E: 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 TYPE OFINSURANCE ADDL SUB I POLICY EFF POLICY UP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2,000,00 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) $ 100,00 X CLAMS-MADE ❑ OCCUR _ MED UP (Any one person) $ 2,50 A X General Liability 1402MFA00008() , 02/05114 02105/15, PERSONAL S ADV INJURY 2;000.00 GENERAL AGGREGATE $•...4,000iOO GGITL AGGREGATE LIMIT APPLIES PER... excluded X POLICY.. PRO-, LGC $ AUTOMOBILELIABILITY;;' COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY (Per Person) $ ALLOWNEDAUTOS BODILY INJURY (Par accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS 79 (Per accident) $ NON-OWNEDAUTOS t S t $ UMBRELLA LIAB H OCCUR ( EACH OCCURRENCE $ EXCESSLIAB CLANS-MADE AGGREGATE s OEOUCTIBI.E ~ $ S S WORKERSCOMPENSATION WC STAN- OTH- AND EMPLOYERS' LIABILITY ~~-LV ANY PROPRIETORPARntlEREXECUII " NIA E, L. EACH ACCIDENT S OFFIOERMEMBER EXCLUDED? (Mandatory in NH) E. L. DISEASEEA EMPLOYE 8 If es, descnloe under RIPGON FOPERATI NSW, EL DISEASE - PIXIDY LIMIT Is I 1402MFAODOOBO 02105114 02105115 IPer Clairn 2,000, A ESOLiability Aggregate 4,DDD,DGC DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (Attach ACORD 101 Additional Remarks schedule, if more space is required) This Certificate of Insurance serves only as evidence of professional (E80) General Liability Coverage. CERTIFICATE DE CANCELLATION CIT32AS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland-Electric DEPT ACCORDANCE WITH THE POLICY PROVISIONS. Attn:' Electric DEPT 90 N. Mountain Ave. AUTHORIZED REPRESENTATIVE Ashland, OR 97520 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD