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CERTIFICATE OF LIABILITY INSURANCE OATEIMM!°D[YYYY)
PRODUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION
CARNEY INSURANCE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
6933 W LINEBAUGH AVE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
SUITE" 102 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
TAMPA, FL. 33625 INSURERS AFFORDING COVERAGE NAIC #
IN5URED IN URLR A AE LIED PROPERTY 8. CASUALTY INS CO
ETZEL ANSV'JERING INC -
if SI IRF:R fs
DBA ANSWER PAGE
It` 3tJRER ; i
3709 CITATION WAY
MEDFORD OR 97504
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COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW NAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOT14,11HS ANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT W11 H RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THL INSURANCF.. AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES AGGREGATE 1M TS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
INSR ADD C POLICY EFFECTIVE POLICY EXPIRATION
L TR INSR". TYPE OF INSURANCE POLICY NUMBER 1 DATE (M MIDDIYYYY) DATE (MMIDDIYYYY) LIMITS
1.000,000
GENERAL LIABILITY 03110l2015 03110;2016 "EA:;ti t U(',<E 1;E $
X ACP BPOC3016581645 ACH E rR t E
X 0101,.1EP11 r W R AI AW_ITY T REt I s Ea oa «en ;r.; 300.000
CLAIM t ,;;5 X ,YL:%IJ2 t1E Ex A~; ,000
,
FER:>:-NA; 3A:?V ;NJIJRY S 1,000,000
L;ENEr? LA +r+L T" S 2,000,000
(A L r EC T 7 IV: I I IC f-i:.R FROLUr.TS ;O. PIO nC $ 2,000,000
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L Pr2
JL_T $
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ALITOMOBILE LIABILITY
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BODILY I 'URY 5
: PROPER IYDAMAGE
GARAGE LIABH.ITY I AU 'r LY-EI 1 r DENT i S
" r I OTHER THAN f fJC $
Al(r:TL?NLY .AGG g
(EXCESS iUMRREI LA t (ARIL ITY t:N 'k 7HREn E 9
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WORKERS COMPENSATION AND 'tt, Sl Atil Tt^
E.iPLOVERS'UABILIrY YI nR L. rS EP
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(Mandatory In NH)
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EL 01-1 POLICY IA0.
OTHER
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DESCRIPTION OF OPERATION" i LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT i SPECIAL PROVISIONS
I HE CITY OF MEDFORD AND ITS OFFICERS, EMPLOYEES AND AGENTS WHILE ACTING WITHIN THE SCOPE OF THEIR DUTIES AS SUCH ARE
INCLUDED AS ADDITIONAL INSURED WHEN REQUIRED BY WRITTEN CONTRACT AS PER ATTACHED FORM #PB Al 07(01-01)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITY OF MEDFORD DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30....-. DAYS WRITTEN
41 1 VVES"T 81 H STREET NOTICE TO THE CERIIFICATE HOLDER NAMED TO THE LEFT LAUT FAILURE T'O DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
,TIVE
MEDPORD OR 97501 AUTHORIZED EPRESEN'F
ACORD 25 (2009101) t_.g 1988-2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized
representative or producer, and the certificate holder, nor does it affirmatively or negatively amend,
extend or alter the coverage afforded by the policies listed thereon.
ACORD 25 (2009101)
EFFECTIVE DATE: 12:01 AM Standard Time, BUSINESSOWNERS
(at your principal place of business) PB Al 07 (01-01)
ACKNOWLEDGEMENT OF ADDITIONAL INSURED STATUS
STATE OR POLITICAL SUBDIVISIONS - PERMITS
RELATING TO PREMISES
Person or Organization Designated as an Additional Insured:
THE CITY OF MEDFORD, OR AND ITS OFFICERS, EMPLOYEES
SEE BLANK ENDORSEMENT PB2500
411 W 8TH ST
MEDFORD OR 975013105
Designated Premises:
3709 CITATION WAY
MEDFORD OR 975049022
This form has been sent to you to acknowledge your status as an additional insured under our, meaning the
issuing Company stated below, insurance policy issued to the Named Insured shown below.
Under our Premier Businessowners Liability Coverage Form, Section Il. WHO IS AN INSURED provides as
follows:
Any of the following persons or organizations are automatically insureds when you i.e. the Named Insured
stated below and such person or organization have agreed in a written contract or agreement that such
person or organization be added as an additional insured on your policy providing general liability coverage.
State or Political Subdivisions - Permits Relating to Premises
Any state or political subdivision which has issued a permit in connection with premises insured by this Policy
which you own, rent, or control is an additional insured, but only with respect to the following hazards:
(1) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings,
canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoistaway openings, sidewalk
vaults, street banners, or decoration and similar exposures,
(2) The construction, erection, or removal of elevators; or
(3) The ownership, maintenance, or use of any elevators covered by this insurance.
HOWEVER, such state or political subdivision's status as additional insured under this policy ends when the
permit ends.
The policy language set forth above is subject to all of the terms and conditions of the policy issued to the Named
Insured shown below. For your information, our Named Insured, the Policy Number, Policy Term and Limits of
Insurance are stated below.
Named Insured ETZEL ANSWERING INC - DBA
Issuing Company: ALLIED P/C INS COMPANY
Policy Number: ACP BPOC3016581645
Policy Term: 03-10-15 To 03-10-16
Limits of Insurance: Per Occurrence $1,000,000
All Occurrences $2,000,000
PB AI 07 (01-01) Page 1 of 1
ACP BPOC3016581645 AGENT COPY 59 16322
i
EFFECTIVE DATE: 12:01 AM Standard Time, BUSINESSOWNERS
(at your principal place of business) PB 25 00 (01-01)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
COMPLETE NAMES & ADDRESSES OF THE ADDITIONAL INSURED
RE: PBA107
THE CITY OF MEDFORD, OR AND ITS OFFICERS, EMPLOYEES AND AGENTS
WHILE ACTING WITHIN THE SCOPE OF THEIR DUTIES AS SUCH.
411 W 8TH ST
MEDFORD, OR 975013105
All terms and conditions of this policy apply unless modified by this endorsement.
PB 25 00 (01-01)
ACP BPOC3016581645 AGENT COPY 59 16323