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HomeMy WebLinkAboutInsurance Certificate: Regenesis Ecological Design Policy Number: Date Entered: 07/31/2015 ACORO~ DATE (MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE _7/31/2015 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 Massingill Harmon Insurance Agency NAME: FAX PHONE (503) 644-7227 (503) 445-0150 12020 SW Barnes Rd LAIC No Extl: (A/C_.I E-MAIL kevin@hargillinsurance.com Portland, OR 97225 ADDRESS INSURER(S) AFFORDING COVERAGE NAIC O# INSURERA Mid-Century Insurance Company INSURED Regenesis Ecological Design INSURER B: INSURER C 426 A ST Ste 102 INSURER D' Ashland, OR 97520 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 TYPE OF INSURANCE ADDLISUBF2' - POLICY-EFF -POLICY EXP-- - - LIMITS LTR IN SD WVD POLICY NUMBER MMIDDIYYYY MM7DDIYYYY COMMERCIAL GENERAL (LIABILITY EACH OCCURRENCE _ S DAMAGE TO CLAIMS-MADE _ OCCUR RENTED PREMISES Ea j MED EXP Any one per n) PERSONAL & ADV INJURY.....,. W_-... - GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE _ S PRO- LOC PRODUCTS COME OP AGG S POLICY JECT L.. OTHER g AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S AUTOMOBILE accdern S I ANY AUTO BODILY INJURY fPer person ALL OWNED SCHEDULED BODILY INJURY iPe, a_ridertAUTOS AUTOS - NON-OWNED PROPERTY DAMAGE HIREDAUTOS AUTOS 1 (Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE c RED RETENTIONS PLR VTH WORKERS COMPENSATION AND EMPLOYERS' LIABILITY _ STATUTE ER VIN ANY PROPRIETOR/PARTNER7EXECUTIVE /31/2015 8/31/2016 EL EACH ACCIDENT $500,000 A (OFFICER/MEMBER EXCLUDEDn Y 'NIA; 'A03148801 ;8 - rrJoo'ooo (Mandatory in NH) E L DISEASE - EA EMPLOYEE o If yes describe under - DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT '500,000 I i I DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION City of Ashland Public Works Dept SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 E Main St THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE i j % i Kevin P. Harmon ` © 1988-2014 ACORD CORPORATION. All rights reserved ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Produced using Forms Boss Plus software ev%v v FormsBoss com Imaressive Publishing 800-208-1977