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HomeMy WebLinkAboutInsurance Certificate: American Industrial Door AMERIND-03 PHITE ACORO P ATE (MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 6/26/2015 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 NAME: Medford Office PHONE FAX 1321 _LAI_C Nod; (541) 779-9187 PayneWest Insurance, Inc. (A/C,-No, El): (541) 779 - - 38 North Central Ave. E-MAIL ADDRESS: Medford, OR 97501 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Western National Assurance Co 24465 INSURED INSURER B : American Industrial Door LLC; American Industrial Door Co. INSURER c : 5022 Table Rock Rd. INSURER D : Central Point, OR 97502 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. INSR - ADDL SUBR - - - - POLICY EFF'. POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR XCPP1059502-03 06/23/2015 06/23/2016 DAMAGE TO RENTED 100,000 PREMISES Ea occurrence $ MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY 'X PRO- LOC r JECT PRODUCTS -COMP/OP AGG $ 2,000,000 OTHER. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident A X ANY AUTO X CPP1058471-03 06/23/2015 06/23/2016 BODILY INJURY (Per person) $ ALL AUTOS OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) rt $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 A ~ CLAIMS-MADE UMB1009693-03 06/23/2015 ~ 06/23/2016 -I AGGREGATE $ 2,000,000 - DEDEXCESS I I RETENTION $ i,. - - 10,000 $ WORKERS COMPENSATION 'PER OTH- AND EMPLOYERS' LIABILITY Y / N STATUTE ER ,ANY PROPRIETOR/PARTNER/EXECUTIVE _ E.L. 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 (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: 2013 Slurry Seal Project #2013-10 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 y ACCORDANCE WITH THE POLICY PROVISIONS. 20 E. Main St. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE at&~ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD