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HomeMy WebLinkAboutInsurance Certificate: Hooper Springs Tree Service Dl A4CC)R" CERTIFICATE OF LIABILITY INSURANCE 055/19/ 9/ DAT/12016 16 t 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). CONTACT 'PRODUCER NAME: PAUL VOLZ INSURANCE AGENCY INC PHONE FAX AIC No Ext : AIC No E-MAIL I ADDRESS: _ 4~0 SISKIYOU BLVD #5 INSURER(S) AFFORDING COVERAGE NAIC# ASHLAND OR 97520 INSURERA : SCOTTSDALE INSURANCE COMPANY , INSURED INSURER B : MATT ISON INSURER C : DBA HOOPER SPRINGS TREE SERVICE INSURER D: PO BOX 3258 INSURER E ASHLAND OR 97520 INSURERF : I 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAYHAVE BEEN REDUCED BYPAID CLAIMS. ILTR TYPE OF INSURANCE I ADDL SUBR POLICY NUMBER MMIDDfYYYY MMIDDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000. h CLAIMS-MADE a OCCUR PREMISES Ea occurrence) $ 100,000. MED EXP (Any one person) $ 5,000• A A X CPS2464460 05/22/2016 05/22/2017 PERSONAL & ADV INJURY $ 1,000,000. 1, 'IN 'L AGGREG~ATIE LIMIT APPLIES PER GENERAL AGGREGATE $ 1,000,000. PRO L~ JECT LOC PRODUCTS - COMP/OP AGG $ 1 ,000,000- POLICY OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OVVNED PROPERTYDAMAGE $ i HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ _ DED RETENTION $ $ WORKERS COMPENSATION SPER TATUTE ORH AND EMPLOYERS' LIABILITY Y I N A.NYPROPRIETOR/PARTNER/EXECUTIVE ❑ NIA E.L EACH ACCIDENT $ r OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under iDESCRIPTION OF OPERATIONS below E.L DISEASE POLICY LIMIT $ ,s I i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is required) TREE SERVICE THE CITY OF ASHLAND, ITS OFFICERS, EMPLOYEES AND AGENTS SHALL BE NAMED AS ADDITIONAL INSURED PER CG2013 - ADDITIONAL INUSRED - STTE OF POLITICAL SUBDIVISIONS - PERMITS RELATING TO PREMISES I CERTCFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN THE CITY OF ASHLAND ACCORDANCE WITH THE POLICY PROVISIONS. i , AUTHORIZED REPRESENTATIVE 20 E MAIN ST ~ ASHLAND OR 97520 ` ©1988-2014 AC CORPORATION. All righ reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD