HomeMy WebLinkAboutInsurance Certificate: Pathway Enterprises (3)
PATHENT-01 DLEONG
ACORO' CERTIFICATE OF LIABILITY INSURANCE DATE(MM(DD/YYYY)
5/9/2014
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 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: Dena Leong
Medford Office PHONE FA%
Paynei Insurance, Inc. (Ai No E.): (541) 779-1321 ac No: (541) 779-9187
38 North Central Ave. - E-MAIL
Medford, OR 97501 ADDRESS, dleong@paynewest.com
INSURER(S) AFFORDING COVERAGE NAIL N
INSURER A: Philadelphia Insurance Co
INSURED
INSURER B
Pathway Enterprises, Inc. INSURER C:
1600 Sky Park Dr. INSURER D
Medford, OR 97504 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 TYPE OF INSURANCE DDLSUBR POLICY EFF POLICY EXP
LTR POLICY NUMBER MM/DD(YYYY MM/DDNYYY LIMITS IMATQ A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00
CLAIMS-MADE ~ OCCUR X PHPK1019706 05/11/2014 06/30/2014 PREEMins s Ea ocrunence $ 100,00
MED EXP (Any one person) $ 5,00
PERSONAL B ADV INJURY $ 1,000,00
GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 3,000,00
X POLICY ] ECT PRO F7 LOC PRODUCTS - COMPIOP AGG $ 3,000,00
OTHER. $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00
Ea accident
A X ANY AUTO PHPK1019706 05/11/2014 0613012014 BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (per accident) $
AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS Per accident
UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,00
A X EXCESS LIAB CLAIMS-MADE PHUB420624 05/11/2014 06/30/2014 AGGREGATE $ 3,000,00
OED RETENTIONS $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS' LIABILITY Y / N STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L. EACH ACCIDENT E
OFFICER/MEMBER EXCLUDED? NIA
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE S
It yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $
DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACORD 101, Additional Romarka Schedule, may be attached Kmom space Is required)
Certificate holder is additional insured per endorsement PI-GLD-HS (10111) #627
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Attn: Karl Olson ACCORDANCE WITH THE POLICY PROVISIONS.
90 N Mountain
Ashland, OR 97520 AUTHORIZED REPRESENTATIVE
11988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD