HomeMy WebLinkAboutInsurance Certificate: Rogue Biofuels Corp A RO CERTIFICATE OF LIABILITY INSURANCE 4A�iZO�4YYY)
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(fes) 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 Ki Haas
NAME:
Elliott Powell Baden and Baker Inc. SAC Fill. (503) -1771 I IA/C Nol: (503)274 -7644
1521 S.W. Salmon Street ADIINFSS. khaasWepbb.com
INSURER(S) AFFORDING COVERAGE NAIC 4
Portland OR 972 05 -17 83 INSURER A :SAIF 36196
INSURED
INSURER B
Rogue Biofuels Corp INSURERC:
PO Box 3422 INSURERD
INSURER E
Central Point OR 97502 INSURERF
COVERAGES CERTIFICATE KIMBER:14 -15 Workers Comp 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 AbbL SUBR POLICY EFF POUCY EXP
LTR TYPE OF INSURANCE INSR WIT POUCY NUMBER IMM/DD/YYYY) IMM/DD/YYYYI LIMITS
GENERAL LIABILITY EACH OCCURRENCE
COMMERCIAL GENERAL LIABILITY PREMISES PREMISES (F
I CLAIMS -MADE n OCCUR MED EXP (Any one person)
PERSONAL&ADV INJURY
GENERAL AGGREGATE 1
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMP/OP AG
I POLICY n 78, n LOC 1
AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT
(Ea accident)
ANY AUTO BODILY INJURY (Per person)
ALL OWNED SCHEDULED BODILY INJURY (Per accident)
AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE
HIRED AUTOS AUTOS UTOS 1Per acciden
UMBRELLA UAB OCCUR EACH OCCURRENCE
EXCESS UAB CLAIMS -MADE AGGREGATE
DED 1 RETENTION$
A WORKERS COMPENSATION X I WC IOT
AND EMPLOYERS' LIABILITY Y N
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT 1,000,000
OFFICER/MEMBER EXCLUDED? I N A
(Mandatory In NH) 770406 5/1/2014 5/1/2015 E.L. DISEASE EA EMPLOYEE 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE POLICY LIMIT 1,000, 000
DESCRIPTION OF OPERATIONS LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, M more space Is required)
CERTIFICATE HOLDER CANCELLATION
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.
20 13 Main Street
Ashland, OR 97520 AUTHORIZED REPRESENTATIVE No\ot ova
Kim Haas /KH
ACORD 25 (2010/05) 1988 -2010 ACORD CORPORATION. All rights reserved.
INS025 (201005).01 The ACORD name and logo are registered marks of ACORD