HomeMy WebLinkAboutInsurance Certificate: Hooper Springs Tree Service
.d► Rai CERTIFICATE OF LIABILITY INSURANCE °"052 014 '
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: H the certificate holder is an ADDITIONAL INSURED, the policy(iss) 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 lieu of such endorsement(s).
PRODUCER CONTACT
NAME:
PAUL VOLZ INSURANCE AGENCY INC P11 E
FA
NC No Ert : N No :
450 SISKIYOU BLVD, STE 5 E41AIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC e
ASHLAND OR 97520 NSURERA: SCOTTSDALE INSURANCE COMPANY
INSURED INSURER B:
MATT ISON
INSURER C:
DBA HOOPER SPRINGS TREE SERVICE INSURER D:
11537 DEAD INDIAN RD INSURERS:
ASHLAND OR 97520 INSURERF:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE 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,
EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMfDDNYYYI MM/OD LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.
J GENERPLLIABILITY DAMAGE To PREMISES R
COMMERCIAL occurrence $ 100,000.
CLAIMS-MODE - FV ] OCCUR MED EXP (Any one person) $ 5,000.
A X CPS1948554 05/22/14 05122115 PERSONAL&ADV INJURY $ 1,000,000.
GENERAL AGGREGATE $ 1,000,000.
GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS -COMP/OPAGG $ 1,000,000.
RO
POLICY ECCTT•L LOC $
comb
AUTOMOBILE LIABILITY (Ea accident) 4
_ e ANY,,TO _ BODILY INJURY (Per person) $
ALL OWNED SCHEDULED
AUTOS AUTOS BODILY INJURY (Per accident) $ -
HIREDAUTOS NON-OWNED PROPERTY DAMAGE
AUTOS (Per accident) $
$
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS LIMB CLAIMS~MADE AGGREGATE $
DIED RETENTION $ $
WORKERS COMPENSATION AM
TORY LIMITS ER
EMPLOYERS'LIABILITY YIN
ANY PROPRIETOR/PAXTNER(EXECUTIVE ❑ NIA E.L. EACHACCIDENT $
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH) EL DISEASE - EA EMPLOYEE $
If yes, describe under
DESCRIPTION OF OPERATIONS below E. L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Aasch ACORD 101, Additional Remarks Schedule, If mom space Is nqulred)
TREE SERVICE
THE CITY OF ASHLAND, ITS OFFICERS, EMPLOYEES AND AGENTS SHALL BE NAMED AS ADDITIONAL INSURED PER CG2013-ADDITIONAL INSRUED -
STATE OR POLITICAL SUBDIVISIONS - PERMITS RELATING TO PREMISES.
i CERTIFICATE HOLDER CANCELLATION - -
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
_ THE CITY OF ASHLAND THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
20 E MAIN ST _ ACCORDANCE WITH THE POLICY PROVISIONS. -
.11
- AUTHORUED REPRESENTATIVE
ASHLAND OR 97520
01988- 1 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD