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HomeMy WebLinkAboutInsurance Certificate: Grayback Forestry ( A~ CERTIFICATE OF LIABILITY INSURANCE DATE MM/DD/YYYY) 12/18/2015 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 . PRODUCER CONTACT NAME: KPD Insurance, Inc. PHONE FAX PO Box 784 iA/c,Na FYtp 541-741-0550 IAJC,N9); 541-741-1674 E-MAIL - - - - Springfield OR 97477 ADDRESS INSURER(S) AFFORDING COVERAGE NAIC_# _ INSURERA:SAIF Corporation -36196 INSURED GRAYFOR02W INSURER B :Zurich American Insurance Co. Grayback Forestry, Inc. INSURER C : PO Box 838 - - - - - - - - Merlin OR 97532 INSURER D INSURER E : i_ INSURER F : COVERAGES CERTIFICATE NUMBER: 2129526527 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 - UBR - POLICY EFF - POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES (Ea occurrence)$ MED EXP (Any one person) $ f~ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY L - i PRO- LOC PRODUCTS - COMP/OP AGG I $ j JECT - - _T - OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident 7 ANY AUTO BODILY INJURY (Per person) $ - - _ AUTOS NED SCHEDULED BODILY INJURY (Per accident), $ NON-OWNED PROPERTY DAMAGE $ - - HIRED AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR ! EACH OCCURRENCE $ EXCESS LIAB AGGREGATE $ CLAIMS-MADE DED RETENTION $ $ A WORKERS COMPENSATION 395606 1/1/2016 1/1/2017 X PER OTH- AND EMPLOYERS' LIABILITY i OFFICER/ IETOR/EXCLUER/ XECUTIVE ❑ N/A WC-9663291 (Multi State) 1/1/2016 1/1/2017 --.L.SCHAC ER__ ~AN (Mandatory in NH) ELI EACH ACCIDENT $500,000 B YIN E L DISEASE EA EMPLOYEE $50010.0.0 i If yes, describe under - DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $500,000 Workers Compensation and Employers Liablity Limits DESCRIPTION OF OPERATIONS I 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. 20 East Main Street Ashland OR 97520 AUTHORIZED REPRESENTATIVE © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD