HomeMy WebLinkAboutInsurance Certificate: Pape Machinery Inc
7 ® DATE (MMIDD/YYYY)
,acoRO CERTIFICATE OF LIABILITY INSURANCE 03/02/2015
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 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 CONTACT
MARSH USA INC. NAME:
PHONE FAX
111 SW COLUMBIA, STE. 500 /c N A/c No
PORTLAND, OR 97201 E-MAIL
Attn: Liz Whiting 503-248-1204 ADDRESS:
INSURERS AFFORDING COVERAGE NAIC #
900810-STND-GAWU-15-16 PM INSURER A : National Union Fire Insurance Company 19445
INSURED INSURER B : N/A N/A
PAPE' MACHINERY, INC.
C/O THE PAPEGROUP INSURER C : NIA N/A
PO BOX 407 INSURER D : N/A NIA
EUGENE, OR 97440 NIA
INSURER E : N/A
INSURER F : Navigators Insurance Company 42307
COVERAGES CERTIFICATE NUMBER: SEA-001998348-39 REVISION NUMBER:2
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 SUER POLICY EFF POLICY EXP LIMITS
LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY
A GENERAL LIABILITY GL 4309787 03/01/2015 03/01/2016 EACH OCCURRENCE _ $ - _-1,000,000
- X DAMAGE TO RENTED 250,000
_COMMERCIAL GENERAL LIABILITY _PREMISES (Ea occurrences $
CLAIMS-MADE 1XI OCCUR MED EXP (Any one person) $ 25,000
X CONTRACTUAL LIAB PERSONAL 8 ADV INJURY $ 1,000,000
X PER LOC AGG $2M GENERAL AGGREGATE $ 10,000,000
GENT AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP/OP AGG $ 2,000,000
X POLICY PRO- LOC $
JECT
A AUTOMOBILE LIABILITY CA 3482083 03/01/2015 03/01/2016 COMBINED SINGLE LIMIT 2,000,000
(Ea accident)
F X ANY AUTO NY15FXR8379531V 03/01/2015 03/01/2016 BODILY INJURY (Per person) $
ALL OWNED SCHEDULED
AUTOS AUTOS BODILY INJURY (Per accident) $
-
NON-OWNED PROPERTY DAMAGE $
X HIRED AUTOS X AUTOS Per accident
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION $ $
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS' LIABILITY Y / N EH_.
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ EL EACH ACCIDENT. $ -
OFFICER/MEMBER EXCLUDED? N/A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS! LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
RE: THE CITY OF ASHLAND, OREGON, AND ITS ELECTED OFFICIALS, OFFICERS AND EMPLOYEES ARE INCLUDED AS ADDITIONAL INSUREDS WHEN REQUIRED BY WRITTEN AGREEMENT OR
CONTRACT AS RESPECTS TO OPERATIONS OF THE NAMED INSURED.
CERTIFICATE HOLDER CANCELLATION
CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
20 EAST MAIN STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ASHLAND, OR 97520 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Elizabeth A. Whiting f z.4.wVA .4.LL1h;A.-P '
C 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 26 (2010105) The ACORD name and logo are registered marks of ACORD