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HomeMy WebLinkAboutInsurance Certificate: HazmatiQ ^ 186023 7 ® DATE (MM/DD/YYYY) A~~ o CERTIFICATE OF LIABILITY INSURANCE 2/18/2015 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 pollcy(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 certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Debbie Archimbaud Commercial Lines - 919 676-8834 PHONE 919-334-2605 FAX fA/G No.Extl -1jA1C No):_.-- Wells Fargo Insurance Services USA, Inc. E-MAIL ADDRESS: debbie.archimbaud@wellsfar9o.com 8540 Colonnade Center Drive, Suite 111 INSURER(S) AFFORDING COVERAGE NAIC N Raleigh, NC 27615 INSURER-A: Great Northern Insurance Company 20303 INSURED INSURER B : Federal Insurance Company 20281 - HazmatlQ by Federal Resources INSURER C: Granite State Insurance Company 23809 235-G Log Canoe Circle INSURER D : Indian Harbor Insurance Company 36940 INSURER E Stevensville MD 21666 INSURER F : COVERAGES CERTIFICATE NUMBER: 8739504 REVISION NUMBER: See below 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. INS -R I— - ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE I D D POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A COMMERCIAL GENERAL LIABILITY 35894855 02/16/2015 02/16!2016 EACH DAMAGE TO OCCURRENCE RENTED- -7- $ 1,000,000 - - - CLAIMS MADE L r- X OCCUR PREMISES JEa occurrence) $ 1 000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 - PRO- r PRODUCTS COMP/OP AGG $ _ 2,000,000 X POLICY JECT LOC OTHER: AUTOMOBILE LIABILITY 73587445 02/16/2015 02/16/2016 COMBINED SINGLE LIMIT $ 1,000,000 A jEa accident) X ANY AUTO BODILY INJURY (Per pers-n) $ $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS _ (Per accident) $ X UMBRELLALIAB X OCCUR 79832965 0211612015 02/16/2016 EACH OCCURRENCE $ 1,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $ - 1 000,000 DIED RETENTION $ $ WORKERS COMPENSATION X PER X 0TH- 1 USL&H C AND EMPLOYERS' LIABILITY WC13673775 02/16/2015 02/16/2016 STATUTE ER Y/N ANY PROPRIETOR/PARTNERIEXECUTIVE ] N / A E L EACH ACCIDENT $ 1000000 OFFICER/MEMBER EXCLUDE D9 1000000 (Mandatory In NH) j E L DISEASE EA EMPLOYEE $ _ If yes, describe under 1000000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ D Professional Liability MTP0041276 02/16/2015 02116/2016 I $1,ooo,ooo II I DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) The City of Ashland, Oregon is included as additional insured for General Liability, Automobile Liability, and Professional Liability as their interest may appear as required by written contract. Coverage is primary and non-contributory. CERTIFICATE HOLDER CANCELLATION The City of Ashford, Oregon SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 East Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE The ACORD name and logo are registered marks of ACORD © 1988-2014 ACORD CORPORATION. All rights reserved. (This 25 (2014/01)70 issued an 2/ia2015> I IIIIIII III IIIIIII IIII VIII IIIIII IIII VIII VIII VIII VIII VIII VIII VIII VIII VIII IIII IIII CVBOtA18/000436 0202 O/0/010' Commercial Lines - (919) 676-8834 Wells Fargo Insurance Services USA, Inc. 8540 Colonnade Center Drive, Suite 111 Raleigh, NC 27615 The City of Ashford, Oregon 20 East Main Street Ashland, OR 97520 Would you like to receive this certificate via email or fax? We offer expedited delivery to better serve our mutual clients. To update the delivery method for revisions to this certificate and for next year's copy, please enter this information in your browser: https://www.cybersure.com/cybersure/forms/iyoc/cdmu.aspx When prompted, enter this information for security purposes: Client ID: 186023 Cert ID: 8739504 Passcode: CA97B14A Follow the instructions and let us know your delivery preference. You'll receive future copies of this certificate via the method you provide. Thank you for helping us provide certificates to you more quickly. I it{1111 III IIIII{i I{II IIIII INIII {{!1 II111 IIIII IIIlI 1!111 INII IIIII IIIII VIII IIIII (III I{II 'CYBOIA18l000436101/02J0/0/0J0'