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HomeMy WebLinkAboutInsurance Certificate: Beaver Tree Service AC" ® DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 5/28/2015 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 NAME: MafCl ZIn11CK Roland King Insurance dba RKI A/C,N o, E,rt : Off: 5414511313 (A/c, No): r-MAIL 1175 S. Main [PO Box 157] ADDRESS: Marci@rkiinc.com INSURER(S) AFFORDING COVERAGE NAIC # Lebanon OR 97355 INSURER A: OHIO SECURITY INS CO 24082 INSURED INSURER B : Ohio Security Ins. Co Beaver Tree Service Inc INSURER C : 270 Wilson Rd INSURER D : INSURER E : Central Point OR 97502 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 INSD WVD POLICY NUMBER (MMIDD/YYYY) (MMIDD/YYYY) LIMITS ✓ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1000000 CLAIMS-MADE FVOCCUR PREMISES (Ea occurrence) $ 1000000 MED EXP (Any one person) $ 15000 A BKS54779670 05/26/2015 05/26/2016 PERSONAL & ADV INJURY $ 1000000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2000000 PRO- [_1 POLICY F-IECT LOC PRODUCTS - COMP/OP AGG $ 2000000 ✓ OTHER: PKGO1 $ AUTOMOBILE LIABILITY (Ea accident) $ 1000000 ANY AUTO BODILY INJURY (Per person) $ B ALL OWNED SCHEDULED AUTOS AUTOS BAS(15)54779670 05/26/15 05/26/16 BODILY INJURY (Per accident) $ NON-OWNED $ HIRED AUTOS AUTOS (Per accident) UMBRELLA LAB HOCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER - ND EMPLOYERS' LIABILITY Y / N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A ❑ E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? 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 (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main Street AUTHORIZED REPRESENTATIVE Ashland, OR 97520 © 1✓988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD