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HomeMy WebLinkAboutInsurance Certificate: Pacific Paving ® DATE (MMIDDIYYYY) ACoRO CERTIFICATE OF LIABILITY INSURANCE 110/12/2015 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 endorsements . CONTACT PRODUCER NAME: KPD Insurance, Inc. PHONE 541-741-0550 FAX 541-741-1674 - _ AIC-No. Ext)' (A/C No) E-MAIL PO Box 784 Springfield OR 97477 a,DDDRE S _ INSURE~~ AFFORDING COVERAGE NAIC # INSURERA:SAIF Corporation 36196 INSURED PACIPAV01 W INSURER B _ - _ - - - - Pacific Paving, Inc. INSURER C : PO Box 2370 INSURER D_ White City OR 97503 INSURER E : - - - - INSURER F COVERAGES CERTIFICATE NUMBER: 2092118783 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, PAID CLAIMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED AD _ POLICY EXP LIMITS - - - D SUBR MMIDDIYYYY ILTR R TYPE OF INSURANCE INSDLIW ID POLICY NUMBER POLICY D MMIDIYYYY LT COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE - $ _ - DAMAGE TO RENTED CLAIMS-MADE OCCUR -PREMISES Eaoccurrence) -J$ F I MED EXP (Any one person) I $ ` PERSONAL & ADV INJURY $ J i i I GEN L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ , - - POLICY PRO LOC PRODUCTS COMP/OP AGG $ - I JECT - OTHER: I $ COMBINED SINGLE LIMIT $ LAUTOMOBILE LIABILITY _(Ea accident - - ANY AUTO j BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident)' $ _ AUTOS - - - - AUTOS { NON-OWNED PROPERTY DAMAGE - $ HIRED AUTOS Per accident) Ir_ AUTOS 1$ UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE, AGGREGATE I r DED T RETENTION $ $ A WORKERS COMPENSATION 812919 10/1/2015 10/1/2016 -X i PETATUTE _ OTHER- AND EMPLOYERS' LIABILITY ANY PRO PRIETOR/PARTNER/EXECUTIVE YIN E.L. EACH ACCIDENT $500,000 NIA~ OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $500,000 (Mandatory in NH) _ - If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $500,000 I DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: All Operations CERTIFICATE HOLDER CANCELLATION 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. 90 N Mountain Ave. Ashland OR 97520 AUTHORIZED REPRESENTATIVEL ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD