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HomeMy WebLinkAboutInsurance Certificate: Hukills Inc ^1 DRA101 C OP ID: CDS CERTIFICATE OF LIABILITY INSURANCE 03128/201 FD (MMIDDNYYY) 6 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: Cindy Propel Insurance PHONE - Sorensen _ -T-FAX formerly United Risk Solutions A/C, No, EXt): 541-245-1111 _ c No : 541-245-1112 E-MAIL - - PO Box 936 Medford, OR 97501-0067 ADDRESS: Cindy.sorensen@propelinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Gemini Insurance Company 10833 INSURED Hukill's Inc., INSURER B : Mutual of Enumclaw 14761 dba Drainpros - - P.O. Box 710 INSURER C : SAIF Corporation - - 36196 - Eagle Point, OR 97524-0710 INSURER D : INSURER E.- 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. INSR TYPE OF INSURANCE NSR SU D POLICY NUMBER M LTR I D/YYYY LIMITS MID/YEYYYMM PLIC IC GENERAL LIABILITY - EACH OCCURRENCE $ 1,000,000 l50,000 -DAMAGE A X COMMERCIAL GENERAL LIABILITY X VOGPOO1613 I 04/01/2016 04/01/2017 g X PREMISES (Ea occurrence) - CLAIMS MADE n OCCUR MQED E (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY PjECT RO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000 000 Ea acciden)_ ~ $ B X ANY AUTO CPPOO1565802 04/01/2016 04/01/2017 BODILY INJURY (Per person) $ It ALL OWNED SCHEDULED BODILY INJURY (Per accident) ! $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE L HIRED AUTOS AUTOS (PER ACCIDENT) - T - - $ UMBRELLA LIAB_ EACH OCCURRENCE $ OCCUR I I EXCESS LIAB CLAIMS-MADE AGGREGATE $ - DED RETENTION $ $ WORKERS COMPENSATION X WC STATU- 'T'- 1 AND EMPLOYERS' LIABILITY TORY LIMITS ER~ _ YIN ( C ANY PROPRIETOR/PARTNER/EXECUTIVE 787769 09/01/2015 O9/O1/2016 EE .L. L. EACH DISEASE - EA ACCIDENT EMPLOYE F~ $ $ 500SOO,000 i OFFICER/MEMBER EXCLUDED? ' N/A ,000 _ „ .,tea - - - !f ycs, Mandatory in NH) (Mandatory - DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 5(w'000 I i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The City of Ashland is Additional Insured as provided by Endt. CG2033 04/13. CERTIFICATE HOLDER CANCELLATION CITAS01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y ACCORDANCE WITH THE POLICY PROVISIONS. 90 N. Mountain Ave. Ashland, OR 97520-2014 AUTHORIZED REPRESENTATIVE C6&•{ -ft- '~PIrANW-%ft-- © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD