HomeMy WebLinkAboutInsurance Certificate: Brotherton Corp
9BROTPI OP ID: MW
0 1 4 )
CERTIFICATE OF LIABILITY INSURANCE 0 D6106/055/
/22014
0
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 I
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 I
certificate holder in lieu of such`endoreemen s..rr,,..
• 'PRODUCER I I
Phone 541 CONTACT -
i Hart lnsurance ( 79-_5521 NAME:..--..-
FaX.541-474-1 190 PHONE F
P. 1BoX 1249 ;T No Ert: T An: NO C 1✓
Gra nts Pass; OR 97528 T E-MaL I - '
i Hart InsuranceAgency - ADDRESS: -
INSURERS AFFORDING COVERAGE NAIC e
- INSURERA: Charter Oak Fire Ins Co 10647
INSURED Brotherton Corporation INSURER B: Travelers Property Casual Co 10647
PO Box 738 rJSURERC:SAIF Cor 36196
Gold Hill, OR 97525
NSURERO:Federal Insurance Co
NSURERE:Travelers Indemnity Co 10647
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.
ILTR TYPE OF INSURANCE POLICY NUMBER MM/DD EFF MMNU P LIMITS Imima GENERAL LIABILITY EACH OCCURRENCE $ 1,000,06
A X COMMERCIAL GENERAL LIABILITY C0526D9764 06/1012014 06/10/2016 PREMISES Ee caunerxx $ 300,08
CLAIMS-MADE a OCCUR MED EXP (Any me pamm) $ 10,00
PERSONAL S ADV INJURY $ 1,000,00
- - - GENERAL AGGREGATE $ 2,000,00
1,r GEN'L-AGGREGATECIMITAPPLIESPER: PRODUCT.COMP/OP AGG' $ 2,000,00
. .Pao- EmpBen:_-". $ 1,000,00 '
e,
POLICY' X LOC
AUTOMOBILE LUIBILITY'..` COMBINED SINGLE LIMIT 11000100
E= JXXYAUTO-._ c:-810526D97"'- 06110/2014. 0611012015 BODILY INJURY (Per Perion)"Y'-
'ALL'OWNED 'SCHEDULED 1 • 1 _
eccidenU f
AUTOS. AUTOSBODILY INJURY (Par ,
HIREDAUTOS NON-OWNED. PROPERTY DAMAGE $
AUTOS Peraccid rt
Deductible $ 2,50
X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 3,000,00
B EXCESS LU1B CLAIMS MADE CUP5261D9764 0611012014 0611012015 AGGREGATE $ 3,000,00
DED X RETENTION$ 10,000 $
WORKERS COMPENSATION WC STATU- X OTHER-TORIY
LIMITS I AND EMPLOYERS' LIABILITY
C ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 944526 1010112013 1010112014 E.L. EACH ACCIDENT $ 1,000,00
OFFICER/MEMBER EXCLUDED? N/A
(Mandatory In NH) E.L. DISEASE-EAEMPLOVEE f 1,000,00
NYes, de¢rhe under - -
DESCRIPTIONOFOPERATIONS tel. E. L. DISEASE-POLICY LIMIT $ 1,000,00
D Equipment 6685778 06/10/2014 06/1012016 Deduct: 2,50
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Addhicnal Remarks Schedule, N more space Is required)
CERTIFICATE HOLDER CANCELLATION
CITYASH
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.
Public Works Dept
20 E. Main Street AUTHORIZED REPRESENTATIVE
Ashland, OR 97520 Hart Insurance Agency
0.
(D 1988-2 10 ACORD CORPORATION. II rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD