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HomeMy WebLinkAboutInsurance Certificate: Building Department Services BUILDEP-01 ROBIN ACORD CERTIFICATE OF LIABILITY INSURANCE F DATE(MM/DD/YYYY) 8/6/2015 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: Hagan Hamilton Insurance PHONE 472-2165 FAX PO Box 847 (A/C, No, Ext): (503 (A/C, No): Mcminnville, OR 97128 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: American States Insurance Company INSURED INSURER B : MaXum Indemnity Company Building Department Services, LLC INSURER C : PO BOX 238 INSURER D : Rogue River, OR 97537 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 LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) ~MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 01CI7118293 08/04/2015 08/04/2016 DAMAGETO(Ea TErante) $ 200,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIFAPPLIES PER. GENERAL AGGREGATE $ 2,000,000 POLICY PRO JECT LOC PRODUCTS - COMP/OPAGG $ 2,000,000 OTHER EMPLOYMENT PRAC $ 10,000 INED idennt) INGLE LIMIT $ 1,000,000 AUTOMOBILE LIABILITY (Ea accc A ANY AUTO 01C17118293 08/04/2015 08/0412016 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS X HIRED AUTOS X AO -OWNED PROP RTY DAMAGE $ S (Per ant) UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ _ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE F.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 $ B Errors & Omissions PFP601332906 08/04/2015 08/04/2016 E&O Limit 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) ***PROOF OF INSURANCE*** CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE City of Ashland 90 N Mountain Ave Ashland OR 97520 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD