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HomeMy WebLinkAboutInsurance Certificate: Rubensteins Contract Carpet OP ID: BG DATE (MM/DD/YYYY) ,aco~zo CERTIFICATE OF LIABILITY INSURANCE 10/08/2015 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 polil 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 NAME ACT Beckie Graves Alfred J. Davis Company PHONE FAX P.O. Box 1776 (A/c No Exq:503-226-3801 (A/c NoT 503-22_6_-0376 Portland, OR 97207 E-MAIL ADDRESS: beckie@alfredjdavis.com N. Dickson Davis PRODUCER RUBEN-1 _CUSTOMERID#:. INSURER(S) AFFORDING COVERAGE NAIC # INSURED Rubenstein's Contract INSURERA: _ Carpet LLC INSURER B : Attn: Stephanie Everett - - - - 1 PO Box 10637 INSURER C : Eugene, OR 97440-2637 INSURERD:SAIF Corp. 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 ;AT DDLISUBRF_ - - POLICY-EFF POLICY EXP LTR POLICY NUMBER I. MM/DD/YYYY MM/DD/YYYY LIMITS INSIR GENERAL LIABILITY EACH OCCURRENCE _ $ DAMAGE TO RENTED - - COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence _ $ CLAIMS-MADE OCCUR I, MED EXP (Any one person) ~ $ _ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GENT AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP/OP AG_ G _ $ PRO- POLICY LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE -1 HIRED AUTOS (PER ACCIDENT) $ NON-OWNED AUTOS $ I J UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB I CLAIMS MADE AGGREGATE DEDUCTIBLE _ $ RETENTION $ $ WORKERS COMPENSATI RA-__.. AND EMPLOYERS'LABILITY _X_ ER Y/ N 10/01/2016 QRY LIMITS_,. OTH- D ANY PROPRIETOR/PARTNER/EXECUTIVE 794537 10/01/2015 E L EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? Y N / A (Mandatory in NH) E L DISEA_ SE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,00001 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: All operations of the named insured CERTIFICATE HOLDER CANCELLATION CITYASH 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 Street Ashland, OR 97520 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD