Loading...
HomeMy WebLinkAboutInsurance Certificate: Lomakatsi Restoration Project ACo & CERTIFICATE OF LIABILITY INSURANCE °"'E"'"°°'"""' 4f21f2014 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 an ADDITIONAL INSURED, the polley(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 ileu of Stich endorsement(s). PRODUCER NAME: Protectors Insurance, LLC ►~~"E~ C Ne: Box 48&9 Medford OR 97504 AD0 INSURER(S) AFFORDING COVERAGE "co INSURERAFirstNational Insurance Cc 24724 INSURED LOMAK-1 INSURER 9:Amedran States of Texas _ -Amercan States Ins Company 10704 Lomakatei Restoration Project Justin Cuilumbine SAT Corporation PO Box 3084 Ashland OR 97520 INSURER E: INSURER F: COVERAGES- - - CERTIFICATE NUMBER: 1108478847 -REVISION NUMBER: THIS IS O CERTIFY INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT NTH 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 NAVE BEEN REDUCED BY PAID CLAIMS. NM TYPE OF WSU RANGE POLICY NUMBER POLICY EFF POLICY EXP Users GENERAL LIABILITY sCC1ew"s 72014 7!2015 EACH OCCURRENCE $1000000 WMMtJtl:IAl litJJ[HAI LIPf11L11T PREMISES a0= a $1,000,000 CWMSMADE I OCCUR MEDE)P(Arq"pe,wri) $10000 LBFPD PERSONAL! ADV INXRY $1,000000 nrNPRA A.ru;FrATF pnonnon GENL AGGREGATE LMR APPLIES PER: PRODUCTS-COMP/OP AGG j 000000 POLICY X PRO- LOC Loggers Broad Fenn $1,000,000 S AUromoBLE LNBar1Y 04OC2286271 72014 72015 (Ea smiderN $1,000,000 MY AUTO BODILY INJIRY(Per mwn) $ ALL OWNED X SCHEDULED BODILY INJURY(PerectiEmnt) $ X1 H AUfT05 NON-0YNED fit $ HIREOAUTOS AUTOS i UMBRELLA UAB X OCCUR O1SU36914300 72014 72016 EACH OCCURRENCE $2000,000 EXCESS UAB CLAJMS44ADE AGGREGATE $2,000,000 GeO X nErcNrI0Ni 10000 $ D WORKERSCOMPENSATION 153 201! 2016 X A AND EMPLOYEW WBLm' M PROPRIETOR/PARTNERA,ECUTIVE Y© N/A E.L EACH AOCDENT 000 OFACELtdE)ASER E(CLUDED? tuarrdetery in NH) E.L. DISEASE -EAEAIPLD $504000 It ~aa. dBamlM OMer DESCRIPTION OF OPERATIONS DNaY E.L. DISEASE -POLICY LMR $ 000 DESORPTION OF OPERATIONSI LOCATIONS/ VEHICLES eTnteh ACORD 101, Addldanal Rmarl,s Seh$ We, Ir mare Maw Is regWreo As additional insured per policy endorsement CG7835(0207): CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THIS ABOVE DESCRIBED POL108S Be CANCELLED SEPORA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland. ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main St Ashland. OR 97520 Aunlorazlxr¢mroONr Tlvc - 01888.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2OlQfO5), The ACORD name and logo am registered marks of ACORD . - City-of-Ashland_Lomakatsi-Restoratio_14-15-GL-AU-U M-WC_4-21-2014_1108478847_1. pdf CDYVBIOAL OEall111L W WIY M 1M Fm«a mm ml Rb b 4b bJYM afd+ rw I h ?1m i 111511f3~ - mmI Wya Paa4 w w traJ J1r bPPY1 « conoaa .~x waedbnM .nb. ~ rp• rYhrr up xm p5 py lba bat Dm1 pp Lmatlrh b¢aWta•d Uft KW Tlm a~nwmB exwu BO FOLCI. rm/aR READ B CAEBa11T. W Pxmb rmbl 4 w mb r rmlm m~DSrhbbaWsmm$ was " YLdAIM da urom6 roaYb/ rrq r•«xbahbladMaw WUM KOS BmOR7MO am✓°ia. ua°~pe' « gatlr.m~e°J«ew ux n Bbavblbal MfbhaaspMMNtl«h M?mP 11Ylb•xsmb•etaPl/b 1r@/ D64dJbmbml IXat)t YvumA •1m •dir• 1 o-aea« CaaEAGJ @wut moan DOMIbOf rRrt M7. Prow mMDr•. tl MA d ammia~noiapwbha m n•anawR lCldDUtRte., W AaYaatp~mMasMb: YrarR+r«0~4 a rm mam•mlwpvbw NW Mb«r'^o ur'ard " wpr,aa/wp gslbb burl NLd aaptl~~w/bvaD anma 4 ro xtltnmm ma nA rofA' b Proabtr•dbpb BLVaM -PER CERFW=79 OF BIaaRABCE a.~/YrmY'. 'ProRb mrgr, « P. mJW•DaJlp lP•Y aYbpmd W W40~«yYww„Mnaraa~ M mWibyNtlrYbtr•brYWay NmOh Pb'bm•YW 4w P~1waW r~kmgatryalfWb m~pwbmgbauaMlmet W lm pw ft. bPM6 « b!p b 14 matl• d gNYa aWd. M.,qL d«p M r9.4v KW Ja Hl"-W AOtlIW1AL D19NN LT YIMRa Y•as «4WbhbCO•!P ~.tlW WxWpµ~ «PrWN ! AWIQYFtlr OR PaANf. M tlfbJ - W bPVmYY• kroxDnD a w'beAP m~/h r MdMn « {Y lr4 r/aro aw DY qab b 'rw• 04. lb barNp FaWlpp b db/ m m 4 AY wtmnaw'aunw a Tm raaM eW nL YiFO' b SoRi •PAP*•a m Y cslW a « 0.9111® PxA11f W IaD WrlbsmmlY h IXProw QasW MAkNNIm y~aY~a~~ avW~r M N ~d wP'!mu PDA~bmrtph'+E erRtlbJ Lm 4Am aPpiw• f! •v/ M t~pewnnapaCJmdemhM6ma-. /aS IJ•. m~'af b•mnPaW aDU~I laia•aDDMbb//aAMRn (4114 farvu QNS rct gbyb 1YWiPYbiyNaMrMMw ba( ys•atr Mr^Ab rwlr Yww w d~tMY Y.pmu. iw MR aM la• rDx•4Y b! Ymnm s phicpmiy ■11/rM. aOlr•Ybhbbdro •Y4b1 Js'Nltla•em</roRJae rr/rbtrv pubDW 4« 1 W W d b aTl mrbrL •DlvxtltlpsoL Sblb IYrn «aP~bJer~tlbGmm - (41~mRJOndwaMMrMr n•rxlmmlhpd4rxtd h MYM. pf m~a.P.O mProADJLb MisaodNY «yyaqfp~W bblbrrggA hD w wwa mb bbo PI T/v aLd+D apx•!om b hi b lmriaAmbap wJmapo«DgY.m fW b Ij4 tl M //IY's• tl Wh ]au Cpap araLRpb MaYHary bypbyp. ~Wr, v ASe~r Ka.p~W qa ~aWM wM1hDaSVME rsabgb NaabOb Oaitr (4 MUanYYwA ~1/.w i.~a.~eb KaY vi WTn hunmm~cPaJma u/pb~y naroam?bwbv~ L lm pYanawp+bdenmbaualn rmdwl$/«itY•v/br14Y'4F NDNOMlm WAiFACMFT AND NONMWEO m•/4ra xmTmMbmmvtlab D~agqtt aagbtrJa. wpW bh AIRUTAFIJABILIn 1EBJB!•lLOPERTT OAAIA06 aABan bh bmtre•«•//b4aratlb LgAq•M~Onyrraykae qqyy 19 llO avixdly. mabwla wd p)~ Mw.ry.✓wa.A~ `ups d GO/RbDE ARafo 9bapbaC MTnr Wrmmb M1atl TO Ym adb tlru h n.°~mre~. Lma l a caaa. rW Prw IM~~Ym «n rw. 4w/..rMrrWWyh4mdm: Jxhx{brmlYw bdr«'. P mB/M7«Prow bbp••abDO a<d h MlvRru, m x L DrarO. T. h••ab Nlbrvr/blrtlwJaa7 liAO• 9KPYy maw•tr «aawRJ av W a rpvmtl pa Ms! hddu CapaPml YJatltlbbnrwambf OPq M,s^nbpavbin abwauaayy ravla VY ruwrw• 19 Prtwerldaw mtaa~my ndJrD CroNq/, MalbmiNba r0o1 tlb W 9vlPxubWd'. w 1m r o0M! hmN b W4 « a1Daa 'I«1/fir. ~«•r_`^,~ 9 bl/~ CO!{lt(DIO4PO COiNRD1DRpP w M11 «pabs'm aMq.b aDD C1 AY NlWIRD-YIMMELt l1ilMOLD DOWIIDN DF PDOLTDIAWV r-9aV/l vq 4b Jll b•44. aaaaq.IX 1W. ulaa•rtrL nJ1aaTbtmM bw Mm Ptl lp avNiLtlM40 pnab1~1 d0FLN11bII p~aan Vl bralw0 ~~qd'~~ pax , -0- lLryba M1bAD)(Stl9Fk gMbbYp OKLFA®11mIGL LAraa~e url W rwmb.lm WN+hgvtlutlYlr wq•MNam mtyp0!bb~atlndbr.x ~L 9caW MM rubaom/Y(uI. M14etR MlYPa1 PRa/.JNYVeddJtlirD.000 h prowmhpYrb«mawe•D b~w1Da•tlh bvaatlaw abr«rabtY/b/Pam~hiMy.lbt dob•xmx: adeJ«Obb sWObe wahmtl wlommoe orottuAlExc[ LUrvumnAar rArwEma-eovenAaa~ wDm W PmWbDOW bYRi ANDL - L•D. LOaW -TWa w ROa M b•llwlb ragpDLOmr bOb W r/Pa FWw' n h y/. W Wl « MAa1R TMNIMwO NDMm M IIaCOYba bM OI Lilt/w. VIM. G1YC 6 M d cabolahhrN/A r/qp1~ twa 6lPRBA]ItINr' rAwbrta - llr bawbD b •mJ b haaroll l ibbP O me~1 abaArL UIMIn NrnODto (4111{MbbpHarWaroaPCndaA CORAAGH AdOLbrabNCghkn+A1F Nnn Ol MeaM'/~YiD OARr NLY dtOLL W.Udp d htlMbmlal er • tgb8UW tr.dWbYa nDw/ allj 6DYDVL W'IIDIn f~9Oaq (!p yp~'am bPf(au•. iW0 R h q wOMmrL4 glw•malh Prow bmsNmfOabe Mmb/NmCaa b~iuM~bw4QbMh~wNVMn /rngf.•a«aldbOproaada,a rW «•Yw LWAY ry . prAqwY eb.w. rTrybawnwrwuarbm wr/ rm RMmmum.wleiwd..u..r~~.n. h LeLY L@q adby C/wl« wgbla xyabJDrlrbl dPD~mb a• W bitlMhAaMawPWaYMeW MmMImY bYob.MxmM /JUMrNYRIaaPaVPMdKa RQAO Oav Mlpalrw•aaar;b/«. b I1bR/. r « RrM 4awh 9a•nora•m•he.«ypW+•W ma LaawRTbertAm rwwo! - rorJMa'laraod•mlutla•mbm Mn upanarieNAt rAM1YRLro DBCLOla Au rrlrpM pL W av IQ a! Otlt hbEn m COIGIbEi AJS L bw{OMq MamrDtlF hl 1R aPbJm W MJd n M ~ppl m+w." roaDSbaapm wxm»mv. Tn.am n>aa b/hM aRr«mbb•pxtmRRpabJbbab•ry L~qy . ba+W m ==M. YnVp b/~naMMF~wg4~pb MtaF Mr1J0a n~1~bMtlb/b1YUnMR urw.rq.m.~wYrY rr..+!+x ruu al/YEq~C M IrbtlarAprr4bmbabp¢Awl«m 1NpdmaMl•tlhtltlvx W. bWwYw•NJalm'W. T-00.1 Baeen of Ya aed•/T•TS YN xOb:~LD~hLrDaO trad.V •eJDbd/adP Wbim -ambphwvl. •lgbblraOl albaaal AODAEaATl JWn Of D~laaAeRL-rFA lrpy ypy/mngW bmda•wmudao ra91YWtlM bdWnmYM alyr L1DLO1'®Aa DtlUAIDt-NGLM GRI albpah nap0en mbdpa D~aT,Maam1 M~M•/b«a•yv btl•Ytl r•Iwv lbIYI.A raJwb WlhhRbl bbms bWiaA• arA~lWw Mai«•r. tlb pbLlmmbmttlYdd mnDW nJ•OahtlbamlDl Td+ surer rYU mm~. My rr~..`.n• ryr~brAr. waw Y^/~^ruY~YS w• rapwds In (4WxtlWtlPb mlmAi P1Pi~LO1(4dDaD6N1Wm®O•c!m arW 0A~E4W8 AlfaLn 0.aeb J~er6rY y.amn~vmwYVAd m ml abrYY00q pNM Udx•aAr 4Ymw/.re««mm/4wam /m1. bjxMraW Mraaa4 mf WrtnrOEC YW[grvrat wL d~JWabbDb^.baeaa/RV brOxabm LILBIAI>tAIIDN CLAIp16 rrwsn W tl w bidam mb al«Pbb Es1aKB) DDVNA06 roL N[IILT KDIB6D m bbYq b rlb! b C0101p1ma ~~~~.hh 4msM DADAADAIJD! ragglsLetl laambaMOim (9q ~~~~n (bap~~ OawwNO ~«y ~YwLI r M Y W wPem.- _ 4r.YMLanM bA4 r+bDDb llydon4b 4aMMbpa 10.1• ~b~OwbaObxMm•1bN Pr rx.vabatluun oFawFA9tE llaDm Dl nlba/ghmwy 40W1'.brw PaMbr haMrohmb« au4 Near«bm~mr dbW/•AJgMad]GRAC b adYWgMYbNd L Crwrpr Wr Db aPYM b alOiDr/ bmaDq by a PaNIxYS• DWYNbI b hh mY awnhh0/bmb/t pvpa• L btyd ba aaa MObbp•fi IRD4b mbW MwtldMpeLy Fmi - YYMemwdle/aDaY Dlr rEAbW ms N[mfi FeD aa(bhmm sab pp «r artIMMO YAdbaT OAYML• xrorlh AClM mbNMmaba 11 o ftl A br mgnr bins a. m ft,abhwdd qty PaAM.aCG'hAM[ A{Wm9Yrrobeq dL•M11/ b)malnom% m7J4 4Mbbahir K/•b1pYe4m1ah1w. ~9Ny rarY'«PWw mD•pa•Oab/ b firnrtM lYrtlfiYOUMbh aMip/LwM mraphtl Mnall Itlu a iw bm am.~ ua w.. b .0"4 hrgr r uwa p M m a .D b MbbbPr b hAidva x•ba[Y bm bpatl glaM Vptl1D. 1Danp.To fi glb•/RmJUlUrmL msaea ft ur a ay or City-of-Ashland_Lomakatsi-Restoratio_14-15-G L-AU-U M-WC_4-21-2014_1108478847_1. pdf