HomeMy WebLinkAboutInsurance Certificate: Ashland Shuttle
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CERTIFICATE OF LIABILITY INSURANCE (MNVDDrrrr)
ACORD' [f04109/2015
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(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 Joel Batmale
N ME:
Gold Canyon Insurance Agency ache 503.
Auburn CA 991-5683 FIAJ, AC Na:
,
Joel laa6ale auDRESS: oel oldean onins,eom
INSURY S AFFORDING COVERAGE NAIC N
INSURFRA:Alano Insurance Company 28339
INSURED Ashland Shuttle LLC INSURER 8:
Nancy Buffington
3925 Highway 66 INBURERC:
Ashland, OR 97250 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.
LTR TYPE OF INSURANCE AD POLICY OFF CY EXP
POLICY NUMBER NIM/DDIYYYY fMWDDnOW) LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
CLAIMS-MADE D OCCUR REMISES Ee o nce $
MED EXP (Any one parson $
PERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
POLICY JECT 7 LOC PRODUCTS- COMP/OP AGG $
$
OTHER;
AUTOMOBILE LIABILnY COMBINED SINGLE LIMIT
coider;l $ 1,000,00
A ANY AUTO OR4000000001-01 0210812016 02/0812016 BODILY INJURY (Par parson) S
F D ALL OWNED X SCHEDULED w
AUTOS AUTOS BODILY INJURY (Pqr accident) $
HIRED AUTOS NON-OWNED PROPERTY DAMAGE
$ (Per AUTOS cciden!
8
UMBRELLA LIAS HOCCUR EACH OCCURRENCE $
EXCESS LUIS CLAIMS-MADE AGGREGATE S
OED RETENTION $ $
WORKERS COMPENSATION R
AND EMPLOYERS' LLIUMLITY STATI ER
ANY PROPRIETOR/PARTNER/EXECUTIVE= YIN E. L. EACH ACCIDENT S
OFFICER/MEMBER EXCLUDED7 ❑ N / A
(Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $
byes, describ. Under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S
DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (ACORD 1D1, Aggltlanal Remarke Sohadulo, may bo attaghgd if more opaeo la raqulrad)
Shuttle Service
2004 Toyota Camry SEDAN 4T1 BE32K24U91977
2007 Toyota Camry SEDAN 57DZK23C17S048388
2009 Toyota Sienna VAN STDZK23CSSS229919
CERTIFICATE BOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLEi3 BEFORE
City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Utillities
20 East Main Street AUTHORIZED RSPRESENTATIVIa
Ashland, OR 87520 Joel Satmale
01988-2014 ACORD CORPORATION. All rights reserved.
ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD
GOLD CANYON INSURANCE SERVICES
FACSIMILE TRANSMITTAL S14EET
TO: FROM:
City of Ash6ftd Joel Batrrmk
COMPANY; DATE:
Gold Canyon Insurance Services April 9, 2015
FAX NUMBER: TOTAL NO. OF PAGES, INCLUDING COVER:
541-552-2059 2
PHONE NUMBER: SENDER'S REFERENCE NUMBER:
503-991-5683
RE: YOUR REFERENCE NUMBER:
Ashland Shuttle LLC [Reference No.]
LI VRGENT X FOR REVIEW ❑ PLEASE COMMENT ❑ PLEASE REPLY C7 PLEASE RECYCLE
a
NOTES/ COMMENTS:
Attached is an updated certificate in addition to the one I sent over on 02/09/2015 £ox
Ashland Shuttle LLC.
Please let me know if you have any questions.
Thanks,
Joel Batmale
Associate
503-991-8683
503-9918446
(STREFT ADDRESS, CITY, ST ZIP CODE]