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Home My WebLink AboutInsurance Certificate: Pape Machinery 212 345-5000 3/28/2016 3:10:09 PM PAGE 2/003 Fax Server DATE (MMIDDNYYY) .acvRV CERTIFICATE OF LIABILITY INSURANCE 03/28/2016 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 NAME: MARSH USA INC. PHONE FAx 111 SW COLUMBIA, STE. 500 A/c No EXt : Arc No PORTLAND, OR 97201 E-MAIL Attn Amy Shafer 503-248-4857 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # 900810STND-GAWU-16-17 PMACH INSURER A : National Union Fire Insurance Company 19445 INSURED INSURER B : N/A N/A PAPE' MACHINERY, INC. C/O THE PAPS' GROUP INSURER C : N/A N/A PO BOX 407 INSURER D : N/A N/A EUGENE, OR 97440 INSURER E : N/A NIA INSURER F : Navigators Insurance Company 42307 COVERAGES CERTIFICATE NUMBER: SEA-002625511-46 REVISION NUMBER:3 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DDNYYY A X COMMERCIAL GENERAL LIABILITY GL 5180113 03/01/2016 03/0112017 EACH OCCURRENCE $ 1,000,000 DAM AGE RENTED CLAIMS-MADE M OCCUR PREM SESOEa occurrrence $ 250,000 X CONTRACTUAL LIAB MED EXP (Any one person) $ 25,000 X PER LOCAGG $2M PERSONALS ADV INJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,000 E❑ LOC PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY ❑ JPROCT OTHER, $ A AUTOMOBILE LIABILITY CA 2961543 03/01/2016 03/0112017 COMBINED SINGLE LIMIT $ 2,000,000 Ea accident F X ANY AUTO NY16FXR8379531V 0310112016 03101/2017 BODILY INJURY (Per person) $ X ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS PROPERTY DAMAGE $ OWNED X HIRED AUTOS X NON-AUTOS Per accident $ UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS LIABILITY Y / N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E. L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) EL DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) RE- THE CITY CF ASHLAND, OREGON, AND ITS ELECTED OFFICIALS, OFFICERS AND EMPLOYEES ARE INCLUDED AS ADDITIONAL INSUREDS WHEN REQUIRED BY WRITTEN AGREEMENT OR CONTRACT AS RESPECTS TO OPERATIONS OF THE NAMED INSURED. CERTIFICATE HOLDER CANCELLATION CITY OFASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 EAST MAIN STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ASHLAND, OR 97520 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Raymond M Schneider way ..~C,Ax~ © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26 (2014/01) The ACORD name and logo are registered marks of ACORD 212 345-5000 3/28/2016 3:10:09 PM PAGE 3/003 Fax Server AGENCY CUSTOMER ID: 900810 LOC Portland ACORO ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED MARSH USA INC. PAPEMACHINERY, INC. C/0 THE PAPE' GROUP POLICY NUMBER PO BOX 407 EUGENE, CR 97440 CARRIER NAIC CODE I EFFECTIVE DATE. ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers' Compensation (continued): Policy #483762 (OR) Insurer: SAW Effective Date: 01/01/2016 Expiration Date: 0110112017 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD