HomeMy WebLinkAboutInsurance Certificate: Grayback Forestry (2)
AeC> & CERTIFICATE OF LIABILITY INSURANCE r DATE
412812014
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: N the certificate holder Is Z; ADDITIONAL INSURED, the policy(les) 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 Ilau of such endorsemend s .
PRODUCER Kendall Yeaw
Protectors Insurance, LLC PNOrE 842-2963 P.O. Box 4669 c N0'
Medford OR 97504 Aooraas:
INSURER(S) AFFORDING COVERAGE NAICe
INSURER A -.Arnerican States Ins Corroany 19704
INSURED GRAYS-1 INKRERB -.American Economy Insurance
Grayback Forestry Inc INSURER c:
Western Emergency Services LLC
PO Box 838 INSURER D:
Martin OR 97532-0838 INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 818208256 - - REVISION NUMBER:
ISSUED THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANYCONTRACT 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
TYPEOR ISIRANCE INSR POLICY {UMBER PAMODYYYY) (MM0DrYYYY1 UMITS
LTR GENERAL LABLrrY iCD11182-50 11/2014 /1/2015 EACH OCCURRENCE It 000000
I.VMMtHL; UtNtHALUPUIUIY REMISES Ea oavFSnca $1,000,000
CLAMS-MADE IT] OCCUR MED EXP (Any ins Person). $10000
Loggers BFPD PERSONAL B ADV IN.URY $1,000000
r.FNFPN GI:GPFDATF $9M00m
GENT AGGREGATE MIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000
POLICY X PRO- 71LOC Loggers Broad Forrn 11,000,000
17 B AUiOMOBI.E LIABILITY - 02CE728304-20 112014 112015 Ee eaio 1000000
ANYAUTO BODILY IN,URY(Par parson) $
AL OVINED SCHEDULED BODILY INJURY (Per aoddn0 $
AUTOS AUTOS
NON-OMED $
HIREDAUTOS AUTOS er acdden
t
UMBRELLA LUe X OCCUR OISLI417067.50 /12014 II2015 EACH OCCURRENCE $2,000,000
EXCESS LIAR CLAIMS-MADE AGGREGATE $2,000,000
DEO nETENrIONt t
WORKERS COMPENSATION A 0
ANDEMPLOYERSIIABLITY YIN - T Y IMR
ANY PROFRIETORUPARTNERIEXE UTIVEā NIA EL.EACHACCDENT $
OFFICERMEMBER E)(CLLGEDP
(Mandatary hr NN) EL. DISEASE-EAEWLO f
Irysa. aesmes V OP
DESCRIPTION OF ERATIONS balm E.L. DISEASE-POIICYIMR $
C EXLrosa Uabmty HA234608 112014 /12015 Polry It $4,000,000
OESCRNPf10NOFOPERATIONSILOCATWNS1YEle S(Auh ACORD10t,AMdonWPa ks Schs o,Ifm onamter 4ArW)
CERTIFICATE HOLDER CANCELLATION
OHOULD 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 E Main St
Ashland OR 97520 AUniORIZED REMiEBQIT
01198".010 ACORD CORPORATION. All fthte reserved.
ACORD 25 (2010105), The ACORD name and logo are registered marks of ACORD .