HomeMy WebLinkAboutInsurance Certificate: Grayback Forestry
ACOO CERTIFICATE OF LIABILITY INSURANCE arzs/zo128/201'°°"""
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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(les) 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
NAME:- Kendall Yeaw
Protectors Insurance, LLC WPHO
C No Ert: 541 842-2963 FAc No: (541)772-1906
P.O. BOX 4669 EMAIL
Medford_ OR 97504 ADDRESS:
INSURER(S) AFFORDING COVERAGE NAICS
INSUREIIRA:AmericanStates Ins Company 9704
INSURED GRAYB-1 INSURER B
Grayback Forestry Inc INSu-R c:
Western Emergency Services LLC INSURER D:
PO Box 838
Merlin OR 97532-0838 INSURER E:
INSURER F :
COVERAGES CERTIFICATE NUMBER: 818208256 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
LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMOONYYY) IMMIDDIYYYYI LIMITS
GENERAL LIABILITY 1CI311182-50 112014 /12015 EACH OCCURRENCE $1,000,000
COMMERCIAL GENERAL LIABILITY PREMISES Eeoaaunence $1,000,000
CLAIMS-MADE IT] OCCUR MED EXP(my one Person) $10,000
Loggers BFPD PERSONAL B ADV INJURY $1,000,000
GENERia AGGREGATE $2,000,000
GENL AGGREGATE LIMIT APPLIES PER PRODUCTS -COMPIOP AGG $2,000,000
POLICY X M, LOC Loggers Broad Form $1,000,000
B AUTOMOBILE LIABILITY 02CE228304-20 1111014 712015 (Ee accident) $1,000,000
ANY ALTO BODILY INJURY (Per person) $
ALL OMED SCHEDULED BODILY INJURY Ecr.ccdent) $
ALTOS NON-OwtlED PROPERTY DAMAGE
HIRED AUTOS ALTOS Perecadenl $
- $
UMBRELLA LIAR X OCCUR 01 SUM 7057-50 112014 112015 EACH OCCURRENCE $2,000,000
EXCESS LIAR CLAIMS-MADE AGGREGATE $2,000,000
DEC RETENTION $ $
WORKERS COMPENSATION VJC STATUS OTH-
ANDEMPLOYERS'.UABILI-Y YIN TORY LIMBS ER
ANY PROPRIETOR/PARTNERIEXECUTIVE. f771 NIA EL.EACHACCIDENT - $ -
OFPICERNIEMBER EXCLUDED
(Mandatory In NH) EL. DISEASE-EAEMPLOYEE $
If yaS, tlesaibe antler
DESCRIPTION OF OPERATIONS belov EL DISEASE-POLICY LMIT IS
C Excess Liability HA234608 112014 /12015 Policy Limit $ 4,000,000
DESCRIPTI ON OF O PERATONS I LOCATIONS I VEHICLES (Adech ACORD 101, AddlOonal Remarks Schedule, if more space la required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE OESCRIBED POLIOIES BE CAN O ELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS.
20 E Main St
Ashland OR 97520 AUTHORIZED REPRESENTATIVE
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