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ACORO® DATE (MM/DD/YYYY)
' CERTIFICATE OF LIABILITY INSURANCE 10/30/2015
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 NAM DML Insurance Services PHONE (206)838-9077 FAX (206)838 9076
W, No
[A/C Nel 4005 20th Ave W Ste 132 W
E-MAIL
Seattle WA 98199-
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A:Ironshore Specialty Ins C
INSURED INSURER B, Praetorian Insurance Co.
Newco, Inc.
Cascade Columbia Distribution Company INSURER c :
6900 Fox Ave S INSURER D
Seattle WA 98108- INSURER E:
I 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.
r-X 1 ADDL SUBR POLICY EFF POLICY EXP LIMITS
TYPE OF INSURANCE POLICY NUMB
X COMMERCIAL GENERAL LIABILITY 1,000787205 10/31/2015 10/31/2016 EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED $ 1,006,006
CLAIMS-MADE - OCCUR 1 111.) X Pollution Liability MED EXP (Any one person) S 10,606
lVen dorsLiability `PERSONAL &ADVINJURY S 1,000,600
GEN'LAGGREGATELIMITAPPLIESPER.GENERAL AGGREGATE $ 2,000,666
POLICY 2,000,000
PRO- I~ LOC PRODUCTS - COMP/OPAGG $
JECT
OTHER : 5
B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
~~y_ PICIS0061678 !110/31/2015 10/31/2016 (Faaccideof)
" ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) Iii $
AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE ! $
HIRED AUTOS AUTOS /Par accident)
S
X 000787905 10/31/2015 110/31/2616 EACH OCCURRENCE $ 20,000,666
A ! UMBRELLA LIAB OCCUR
X 1 $ 20,000,000
i EXCESS LIAB CLAIMS-MADE i ! DED X RET NTION 16,606 $
A WORKERS COMPENSATION 000787205 10/31/2015 10/31/2016 'T'RTUT, OTH-FR i
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE Y~ N / A iVVA Stop-Gap E.L. EACH ACCIDENT $ 1'666'666
OFFICER/MEMBER EXCL UDF D? L 1,000,QQQ
j (Mandatory in NH) PE L, UISLASE - EA EMPLOYtE $
yes, describe under 1,000,000
E.L. DISEASE - POLICY LIMIT $
PT 0 N PERATIONS below
DE -I
1 I
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CERTIFICATE HOLDER CANCELLATION A11570
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Attn: Kan Olson - Purchasing ACCORDANCE WITH THE POLICY PROVISIONS.
90 N Mountain Avenue
Asland OR 97526- AUTHORIZED REPRESENTATIVE
O 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD