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HomeMy WebLinkAboutInsurance Certificate: Grayback Forestry Inc AC4ORa DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 12/15/2014 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 endorsements . PRODUCER CONTACT NAME: KPD Insurance, Inc. PO Box 784 MM 541-741-0550 Fax 541-741-1674 Springfield OR 97477 E-MAIL ADDRESS* INSURERS AFFORDING COVERAGE NAIC # INSURERA:SAIF Corporation 36196 INSURED GRAY03W INSURERB:Zurich American Insurance Co. Grayback Forestry, Inc. INSURER C: PO Box 838 Merlin OR 97532 INSURER D: INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 1753490047 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 TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR INSD D POLICY NUMBER MM/DD/YYYY MM/DD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE 171 OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JJERCT F-] LOC PRODUCTS - COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY O BINEDt SINGLE $ (Ea acciden_ ANY AUTO BODILY INJURY (Per person) $ HEDULED BODILY INJURY (Per accident) $ AUTOWNED H SC UTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ - AUTOS Per accident $ UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DIED RETENTION $ $ A WORKERS COMPENSATION 395606 1/1/2015 1/1/2016 PER OTH- A AND EMPLOYERS' LIABILITY Y/N 963584 1/1/2015 1/1/2016 X STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA WC-9663291 (Multi State) 1/1/2015 1/1/2016 E.L. EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $500,000 Workers Compensation and Employers Liablity Limits DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more spage Is required) Re: All Operations 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 97520 AUTHORIZED REPRESENTATIVE © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD