Loading...
HomeMy WebLinkAboutInsurance Certificate: Rubenstiens Contract Carpet LLC OP ID: BG CERTIFICATE OF LIABILITY INSURANCE F DATE (MM/DD/YYYY) 10/02/2014 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). CONTACT PRODUCER 14AME: N. Dickson Davis Alfred J. Davis Company PHONE 503-226-3801 aC No :503-226-0376 P.O. Box 1776 A/c No EXt Portland, OR 97207 ADDRESS: beckie alfred'davis.com N. Dickson Davis PRODUCER RUBEN-1 CUSTOMER ID INSURER(S) AFFORDING COVERAGE NAIC # INSURED Rubenstein's Contract INSURER A:SAIF Corp. Carpet LLC INSURER B : PO Box 80544 INSURER C Seattle, WA 98108-2570 INSURER D : 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 ADDL SUB POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE 1:1 OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ rAB PRO- F7 LOG $ ILITY COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY (Per person) $ UTOS BODILY INJURY (Per accident) $ AUTOS PROPERTY DAMAGE $ (PER ACCIDENT) AUTOS $ UMBRELLA LIAB TOCC7UR EACH OCCURRENCE $ EXCESS LIAB AGGREGATE $ DEDUCTIBLE RETENTION $ WORKERS COMPENSATION WC STATU- X OTH- AND EMPLOYERS' LIABILITY T RY LI IT ER A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 794537 10/0112014 10/01/2015 E. L. EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? NIA 1,000,00 (Mandatory in NH) E. L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE -POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) re: All Operations CERTIFICATE HOLDER CANCELLATION CITYASH SHOULD ANY OF THE ABOVE DESC LICIES BE CANCELLED BEF THE EXPIRATION DATE THEREO ICE n L B% D~fttRED City of Ashland ACCORDANCE WITH THE POLICY PR S S. VV 20 East Main Street Ashland, OR 97520 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD