HomeMy WebLinkAboutInsurance Certificate: TerraSurvey Inc
From Ashland Office #1 Fax: To: +15414885320 Fax: +15414886320 Page 2 of 2 06/04t20149.49
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CERTIFICATE OF LIABILITY INSURANCE 6/4/2014
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(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 endoreement(s .
IRODUCER CO TA Julie Asher
Ashland Insurance Inc P DNE (541)482-0831 FNC! .ISall 499-sesl .
585 A Street Suite 1 Apl)g .jaeher@ashlandineurance.com
P. O. Box 880 INSUREiS AFFORDING COVERAGE NAIC0
Ashland OR 97520 INSURER A:FOrQMOS t Insurance Company
INSURER B;Llbar Northwest Companies
TerraS=ey, Inc. INSURER C:
274 4th Street INSURER.:
INSURER E:
Ashland OR 97520-2044 INSURER F:
COVERAGES CERTIFICATE NUMBER:CL145504776 REVISION NUMBER:
THIS 15 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTIAATHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WfTH 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.
LSR TYPE OF INSURANCE AmILSUSH I= im POLICY NUMBER MMUCYEFF POLICY EIIP LIMITS
GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000
X COMMERCIAL GENERAL LIABILITY a omOimnco S 1, 000, 000
A CLAJM5-0MDE ā¯‘X OCCUR X A8043357319 /10/2014 /10/2015 MED FXP one anon 5 10,000
PERSONAL B ADV INJURY S 1,000,000
GENERAL AGGREGATE s 2,000,000
GENT. AGGREGATE LIMIT APPLIES PER PRODUCTS -COMWOP AGO 5 2,000,000
X POLICY PRO- LOC 5
AUTOMONUILIABILITY COMBINED OMIT
d 11000,000
B ANY ArO BODILY INJURY (Per person) S
AALLOWNEU X SCHEDULED 13151749 0/30/2013 0/30/2014 BODILY INJURY (Per aaldml) 5
HIRED AUTOS NON-OWNED PROPERTY DAMAGE
AUTOS Pa aceldepIl $
Unkramd motorist combined S 1 000 000
UMBRELLA LIAR OCCUR EACH OCCURRENCE 5
EXCESS LUIS CLAIMS44AOE AGGREGATE S
DEO RETENTIONS 5
WORKERS COMPENSATION WC STATU- DTH-
ANDEMPLOYERSLIABILITY YIN CRY I IM". PR
ANYPNOPRIETOIUPARTNSRIEXECUTIVEā¯‘ NIA EL EACH ACCIDENT 5
OFFICFARAEMBER E%CLUOE07
(Mandemr In NH) EL DISEASE - EA EMPLOYE 5
If yea dsecbe under
DESCRIPTION OF OPERATIONS E Iow EL DISEASE - POLICY LIMIT
S
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AUadi ACORD 101, AddlUand Ranvrie Schedule, if non sposo ie roquind)
The City of Ashland Its Elected Officials, Officers and Employees are listed as additional insureda.
CERTIFICATE HOLDER CANCELLATION
(541)488-5320 SHOULD 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 M MOFUe. REPRESENTATIVES
Julie Asher
ACORD 25 (2010105) 988-2010 ACORD CORPORATION. All rights reserved.
INS025 poillas).o1 The ACORD name and logo are reglst marks of ACORD