HomeMy WebLinkAboutInsurance Certificate: Grayback Forestry (3)
® DATE (MMIDDIYYYY)
ACORN CERTIFICATE OF LIABILITY INSURANCE
IIIII 12!22!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 NAME: Kendall Pori
Protectors Insurance, LLC a.ic°NNo Ext :541 -842-2963 FAArc No :541 772 1906
P.O. Box 4669 E-MAIL
Medford OR 97504 ADDRESS: kendall protectors ins.com
INSURER(S) AFFORDING COVERAGE NAIC #
INSURERA:Amerlcan States Ins Company 9704
INSURED GRAYB-1 INSURERB:Ameriean Economy Insurance
Grayback Forestry Inc INSURER C:
Western Emergency Services LLC INSURER D:
PO Box 838
Merlin OR 97532-0838 INSURERS:
INSURER F :
COVERAGES CERTIFICATE NUMBER: 1677148799 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS
LTR INSR WVD POLICY NUMBER MMIDDfYYYY MMIDDIYYW
A GENERAL LIABILITY 01-CI-311182-70 1/112016 1/1/2017 EACH OCCURRENCE $1,000,000
x MAMA'- T(1 RF~ITM
COMMERCIAL GENERAL LIABILITY PP.EMISES Ea occurrence $1,000,000
CLAIMS-MADE [XI OCCUR MED EXP (Any one person) $10,000
PERSONAL & ADV INJURY $1,000,000
GENER,wAGGPFGATF $2,000,000
GEN'LAGGREGATE LIMIT APPLIES PER. PRODUCTS - COMPlOPAGG $2,000,000
POLICY X PRO- LOC Loggers Broad Form $1,000,000
T
B AUTOMOBILE LIABILITY 02-CE-22830440 1/1/2016 1/1/2017
(Ea accident) $1,000,000
X ANY AUTO BODILY INJURY (Perperson) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS AUTOS
DAMAGE
NON-OUM;ED PROPERTY ead $
HIRED AUTOS AUTOS P
A UMBRELLA LIAB X OCCUR 01-SU-417057-70 11112016 1/112017 EACH OCCURRENCE $2,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETEIVTIGN $ $
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS' LIABILITY Y f N TORY LIMITS ER
E.L. EACH ACCIDENT $
ANY PROPRIETORIPARTNERIEXECUTIVE N/A
OFFICEPMIEMBER EXCLUDED?
(Mandatory in NH) E.L. DISEASE- EA EMPLOYEE $
If yes, describe under
DESCRIPTION OF OPERATIONS below E L. DISEASE - POLICY LIMIT $
I
DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
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 E Main St
Ashland OR 97520 AUTHORIZED REPRESENTATIVE
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