HomeMy WebLinkAboutInsurance Certificate: Geometrix Northwest FROM:focusl TO:5414885311 06/20/201411:51:01 #57861 P.001/001
~i Phone: (641)488.6002 Fax: (541)488-6311
ACOR& CERTIFICATE OF LIABILITY INSURANCE DATE(MMXIDIYVYYI
06120/2014
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. TH113
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 pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the tome and conditions of the policy, certain policies may require an endorsement A statomant an this certificate does not center rights to the
cartiflcate holder In Ilan of Such endoreemen s .
PRODUCER CONTACT JUSTIN WOOOSIDE
Focusl Insurance Group, Inc PHONE - IN FAX
3110 State Street -MAIL Enr 641-772-3130 uc•eRr. SN-772-790D
E
Medford, OR 97504 -ADDRESS; juatln~focuetlne.com
License 100171325 INSURER a AFFORDING COVERAGE _ IWO a
INSURER A: LIhllftY„l)<]](X W.....-.._...._
INSURED NORTHWEST GEOMETRONICS, INC INSURER B: Cfirtain
UndBlWrIt6293LLieySt9w.LgBQ(TD. DBAGEOMETRIXNORTHWEST INSURER R CC:
4354 SARDINE CREEK R FORK RD INSURER
GOLD HILL, OR 97525 INSURER E:_.-.._.. _
INEURER F
COVERAGES CERTIFICATE NUMBER: 00008124-98609 REVISION NUMBER: B
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 CONTRACTOR OTHER DOCUMENTWITH 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.
INen--1rPE Of INSURANCE AO sue POUCYNUMBER POLICY EFF POLICY EXP LIMITS
A GENERAL LIABILITY y BK3 (15) 56133160 0m24 zou oW242016 RRENCE s 1 000 000
REN Ep
MEROAL GENERAL LIABILITY ES RFVNtQP.W1. 1000
000
CLAIMS MADE U OCCUR Pna son F 15 000.
]ADV INJURY ] 1000000
r,
GCJiE(iTTE `L00D•000
GE NL AGGRFGATF LIMI T AP MIE S PER ~ COMP/OP AGG S 2000000
-FIT POLICY PRO- LOC ]
A AUTOMOBME LIABILITY BAS (15) 56133160 051242014 051242015 OSINED SINGLE LIMIT ddmi
ANY AUTO BODILY INJURY PAr"mtm) ]
ALL OWNED SCHEDULED
j AUTOS IX AUTOS BODILVIWURY IPOI a0tlOM0 ]
_ NowotvNEO PROPERTY OAMAGE
X HIRED AUTOS X At IT(* ]
]
A UMBRFIUUAB j OCCUR ESO (16) 56133160 0612412014 061242016 EACH OCCURRENCE, 3 11000 000
X EXCERSLIAB X I`LAIMS MADE AGGREGATE ] 1,000,000
I DEO RETENTION] It
WORKERS COMPENSATION R95TATU 1T
AND EMPLOYERS' LIABILITY YIN .TABYUM
ANY PROPMETORIPARTNER/FJIECUTNF. ❑ E.L. EACH A(:(:IDENT
W KICE"EMSEREACLUDED] NIA _
IMAMirl"in "I E L: CIS EASE- EA EMPLOYE ]
11 Yes. 4sw" WAO,
DE CRIPTIONOFOPERATIGNSOBION P L DISEASE. P(X,ICV LIMIT 3
B Professional Liablll PGIARK03808-00 05127120+4 osr2712016 Pro]eaalonal LIab11 2,000,000
DESCRIPTIONOFOPER nT SILOCATION61VEHICLES IA"mh ACORD 101,AdMooal RAm.M. Schsdul, it mom Lpw a mgwmd)
Land Surveying S Mapping Services
Ivy Lane/Morton St. & Ashland Loop Rd.
CERTIFICATE HOLDER CANCELLATION
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 East Main Street
ASHLAND, OR 97620 AuTHOmz L
~
(JUW)
1988- 010 CORD CORPORATION. All rights reserved.
ACORD 26 (2010106) The ACORD name and logo are regi arks of AGWD
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