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HomeMy WebLinkAboutInsurance Certificate: Copeland Construction (2) 7 ® DATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 6/3/2015 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 Jessica Embree NAME: Zarosinski-Leavitt Insurance Agency of Oregon PHONE (503) 639-4220 AIX No: (503)639-4449 IA/C. No. Leavitt Group of Portland E-MAIL DRESS: 8285 SW Nimbus Ave, Ste 120 INSURERS AFFORDING COVERAGE NAIC# Beaverton OR 97008 INSURER A:Ameri can Hallmark Ins Co of TX 43494 INSURED INSURER B :SAIF 036196 Copeland Construction LLC INSURERC: 321 Pruett Rd. INSURER D: INSURER E Eagle Point OR 97524 INSURER F: COVERAGES CERTIFICATE NUMBER:15/16 pckg 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. INSR TYPE OF INSURANCE INADDLSUBRI SR WVD POLICY NUMBER MM DDY LTR /YYYY MM/DD//YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ A CLAIMS-MADE OCCUR 44CL464731-05 6/3/2015 6/3/2016 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 A X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED L SCHEDULED 44CL464731-05 6/3/2015 6/3/2016 BODILY INJURY (Per accident) $ AUTOS AUTOS DAMAGE $ NON-OWNED PeOr accident) HIRED AUTOS AUTOS PIP-Basic $ X UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ 1000000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1000000 DED X RETENTION$ 10,000 44CU476415-03 6/3/2015 6/3/2016 $ B WORKERS COMPENSATION X O STATURY ER AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L. EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? 980838 1/1/2015 1/1/2016 (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ 5 00 , 000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500 , 000 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. 90 N Mountain Ashland, OR 97520 AUTHORIZED REPRESENTATIVE J Embree, Exec/JDE ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 (201005).01 The ACORD name and logo are registered marks of ACORD