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HomeMy WebLinkAboutInsurance Certificate: Lomakatsi Restoration Project (2) ' ® DATE (MMIDD/YYYY) ACORO CERTIFICATE OF LIABILITY INSURANCE Ill 1 5/22/2015 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 _NAMEe T Kendall_Yeaw _ Protectors Insurance, LLC H NN. Ext):(541)842-2963 FAAic No :0772-1906 P.O. Box 4669 E-MAIL Medford OR 97504 ADDRESS:kendaliva-.orotectorsins.com INSURER(S) AFFORDING COVERAGE _ NAIC # INSURER A :SAIF Corporation INSURED LOMAK-1 INSURERB:First National InSUranCe CO 4724 Lomakatsi Restoration Project INSURER C :American States of Texas Justin Cullumbine INSURERD:American States Ins Company 19704 PO Box 3084 D- Ashland OR 97520 INSURER E: _ INSURER F : COVERAGES CERTIFICATE NUMBER: 691576448 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 ADDL SUBR - - POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER MMIDD/YYYY MMIDDIYYYY LIMITS B GENERAL LIABILITY 25CC1600449 /17/2015 /17/2016 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY III PREMISES (Eaoccurrence) $1,000,000 CLAIMS-MADE X OCCUR LMED EXP (Any one person) $10,000 Imo- - I _NI ED PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP/OP AGG $2,000,000 POLICY PRO LOC Loggers Broad Form $1,000,000 UUMbliNtUZ C AUTOMOBILE LIABILITY 04CC2285275 /17/2015 /17/2016 E a accident) $1,000,000 _ _ ANY AUTO BODILY INJURY (Per person) ALL OWNED SCHEDULED AUTOS X AUTOS BODILY INJURY (Per accident): $ L NON-OWNED PROPERTY DAMAGES X HIRED AUTOS AUTOS Per accident D UMBRELLA LIAB X OCCUR 01 SU43335510 /17/2015 4/17/2016 EACH OCCURRENCE $2,000,000 EXCESS LAB CLAIMS-MADE [AGGREGATE $ DED X RETENTION $10,000 A WORKERS COMPENSATION 992153 4!1/2015 4/1/2016 X WC STATU- OTH- AND EMPLOYERS' LIABILITY LIMIT - ER Y/N TORY ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N I A E L EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? I (Mandatory in NH) E L DISEASE EA EMPLOYEE $500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $500,000 li I I I I DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) As additional insured per policy endorsement CG7635(0207): 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. 20 East Main St Ashland OR 97520 AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD