HomeMy WebLinkAboutInsurance Certificate: Key Manufacturing & Rentals
KEYM01C OP ID: SHJ
2014Y)
CERTIFICATE OF LIABILITY INSURANCE 0 D3/26/
/2014
03/26
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 WANED, 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 Phone: 541-245-1111 CONTACT Nikki Russell
NAME:
United Risk Solutions, Inc. Fax: 541-245-1112 PHONE 541-245-1111 FAX
PO Box 936 AIC N sfl: (A/C No: 541-245-1112
Medford, OR 97501-0067 E-M,vL
ADDRESS: nikki.russell@unitedrisk.com
INSURERS AFFORDING COVERAGE NAIC p
INSURER A: Mutual of Enumclaw 14761
INSURED Key Manufacturing INSURER B:
& Rentals Inc.
18179 SW Boones Ferry Rd. INSURER C
Portland, OR 97224-7672 INSURER D
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 ADDL U POLICY TR TYPE OF INSURANCE JN= n POLICYNUMBER MDDEFF M(MMtDDNYYY) POLICY EXP
LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
A X COMMERCIAL GENERAL LIABILITY X CPP0010970012 04/01/2014 04/0112015 PREMISES Ee occurrence $ 1,000,000
CLAIMS-MADE OCCUR MED EXP(My one person) $ 10,000
PERSONAL &ADV INJURY $ 1,000,00
GENERALAGGREGATE $ 2,000,00
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00
X POLICY [_1 JFCT F7 PRO LOC $
AUTOMOBILE LIABILITY EOMaBGINdEeDSINGLE LIMIT $ 1,000,000
A X ANY AUTO CPP001097002 0410112014 04/01/2015 BODILY INJURY (Per person) $
ALL OWNED SCHEDULED
AUTOS AUTOS BODILY INJURY (Per accident) $
NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS Per amident
UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 1,000,00
A X EXCESS LAB CLAIMS-MADE UM0000211201 04101/2014 04/01/2015 AGGREGATE $ 1,000,000
DED X RETENTION$ 10'000 $
WORKERS COMPENSATION WC STATU- OTH-
ANDEMPLOYERS'LABILTY YIN T RV IMIT ER
ANY PROPRIETOR/PARTNER/EXECUTIVE NIA EL EACHACCIDENT $
OFFICEWMEMBER EXCLUDED?
(Mandatory in NH) E.L. DISEASE- EA EMPLOYE $
If yes. describe under
DE SCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
A Inland Marine CPP001097002 04/01/2014 04/01/2015 Ded. 2,50
Equipment Rent/Leas 100,00
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is requlned)
City of Ashland, Oregon and its elected officials, officers and employee are
additional insured with primary and non-contributory coverage per forme
CG20206 07/04 and ME8802 12/01.
CERTIFICATE HOLDER CANCELLATION
CITAS03
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 97520-1814 AUTHORUMD REPRESENTATIVE
01988.2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD