HomeMy WebLinkAboutInsurance Certificate: Grayback Forestry Inc (2)
lYYYY)
12/31DATE/22014
AC" CERTIFICATE OF LIABILITY INSURANCE
014
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).
PRODUCER
NAME: KQ~1 I) YeaW
Protectors Insurance, LLC PHONE FAX
P.O. Box 4669 Ea(-M NAIL o Extz 541 842-2963 _~LArc No)_(541 772_1906._.____-.
Medford OR 97504 ADDREss_kendallyCo).pr~.tectorsin~s.com
INSURER(S) AFFORDING COVERAGE NAIC f
INSURERA:Amerlcan States Ins Com an 9704
INSURED GRAYB-1 INSURER B:American Economy Insurance
Grayback Forestry Inc INSURER C
Western Emergency Services LLC INSURER D:
PO Box 838
Merlin OR 97532-0838 INSURER E_-_ -
INSURER F :
COVERAGES CERTIFICATE NUMBER: 1546014463 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.
POLICY EFF POLICY EXP
INSR TYPE OF INSURANCE ADULISUBRI
LTR INSR WVD ; POLICY NUMBER MMIDDIYYW MMIDDIYYYY LIMITS
A GENERAL LIABILITY N ~1C131118260 /1/2015 /1/2016 - -
EACH OCCURRENCE $1,000,000
X COMMERCIAL GENERAL LIABILITY )AMA(' u N r
PP.EMISES (Ee occurrence) $1,OOQ000
CLAIMS-MADE OCCUR MED EXP (Any one person) $10,000 _
X Loggers BFPD
~ i PERSONAL & f:DV IN.uRY $1,000,00_0-- _
GENERAL AGG PEGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER FRODUCTS-COMPOPAG3 $2,000,000
POLICY X PRO- LOC j Loggers Broad Form 61,000,000
B AUTOMOBILE LIABILITY
02CE22830430 /1/2015 /112016 Eaaccident X1,000000
- -
X ANY AUTO BODILY IDJJ_iRY (Per person) $
ALL OWNED SCHEDULED
AUTOS AUTOS ~ BODILY IhJ,w_lR'Y' (Pei eccidenq $
NON-OVWIED PROPERTY DAMAGE
HIRED AUTOS AUTOS Peraccident)
$
A X UMBRELLA LIAB X OCCUR 01SU41705760 11/2015 /112016 EACH OCCURRENCE $2,000,000
EXCESS LIAB CLAIMS-MADE AG=F'EGATE $2,000,000
DED RETENTION $ $
WORKERS COMPENSATION VVC STATU- OTH-
v Y LIMI• S _ER _
AND EMPLOYERS' LIABILITY YIN - -i-__
ANT' PROPRIETOR/PARTNER/EXEUJTIVE
E L EACH ACCIDENT $
OFFICERIMEMBER EXCLUDED? N!A
(Mandatory in NH) E L DISEASE - EA EMPLOYEE $
If -T descat,under
DESCRIPTION OF OPERATIONS below E L. DISEASE-PC~LiC'r' LIMIT $
i
I
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
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.
20EMain St
Ashland OR 97520 AUTHORIZED REPRESENTATIVE
Q 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD