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HomeMy WebLinkAboutInsurance Certificate: Mountain View Paving (2) ,nco CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 116.1 ~ 9/28/2015 THIS -ERTIFICATE 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 NCONTACT AME. Kim Schnetzky Ward Insurance Agency PHONE (541) 687-1117 FAX (A/C,. No, Ext): (A/C, No): (541) 342-8280 PO Box 10167 ADDRESS: kim@wardinsurance.net - INSURER(S) AFFORDING COVERAGE NAIC # Eugene OR 97440 INSURERA:Depositors Ins Company '42587 INSURED INSURER _B Mountain View Paving, Inc. INSURER C PO Box 508 INSURER D INSURER E:_. Talent OR 97540 INSURER F COVERAGES CERTIFICATE NUMBER:15/16 GL/AL/UMB 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 LTIR TYPE OF INSURANCE AODL SUBR - -POLICY EFF POLICY EXP POLICY NUMBER MM/DD/YYYY 'MM/DD/YYYY LIMITS T~ MERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X CO LX -1 ~ DAMAGE TO RENTED _ CLAIMS-MADE OCCUR DEMISES (Fa occurrence) 300,000 X Y ACP7526305292 9/25/2015 9/25/2016 ; MED EXP (Any one person) $ 10 , 000 PERSONAL & ADVINJURY i$ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X J CT ` 1 LOC PRODUCTS - COMP/OP AGO I$ 2,000,000 -~I OTHER: ! $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 accident) JEa A X ALL ANY OWNAUTOED S AUTOS CHEDULED ACP7526305292 9/25/2015 9/25/2016 BBODILY INJURY ODILY INJURY ((Per accident) $ ~ NON-OWNED OWNED $ I~ PPRPERTY eoa cden~lAMAGE $ X MREDSAUTOS X $ UMBRELLA LIAB 11 X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB r - - A CLAIMS MADE AGGREGATE $ 1 , 000, 000 DED RETENTION $ ACP7526305292 9/25/2015 9/25/2016 $ WORKERS COMPENSATION - PER li OTH- I Y/N ~I( AND EMPLOYERS'LIABILITY ANY PROii ET HR/P CLUDE/EXECUTIVE E L . DISEASE STATUTE A DENT _ EMPLOYEE ~ E L. EACH ACCT (OFFICER/MEMBER EXCLUDED N/A - $ i Mandatory I If es, describe under - v be !ow 'I $ DESCRIPTION OF OPG P4TION° E.L. DISEASE - POLICY LIMIT $ Ii I i I !I li I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Patches City of Ashland is named as additional insured on a primary and non-contributory basis including waiver of subrogation with respects to work performed by the named insured under written contract agreement and per the attached CG7323. Completed operations apply per the attached CG7246. 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 90 N. Mountain ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE Da--r--n Godfrey/TRACEE © 1988-2014 ACORD CORPORATION. All rights reserved. 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