HomeMy WebLinkAboutInsurance Certificate: Beaver Tree Service
1 DATE (MM/DD/YYYY)
'`~~R°® CERTIFICATE OF LIABILITY INSURANCE 5/25/2016
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 NCONTACT
AME: Marcl Zimick
FAX
Roland Kin Insurance dba RKI PHONE Off: 5414511313
King A/C, No, Ext : (A/C, No):
L-MAIL
1175 S. Main [PO Box 157] A
DDRESS: Marci@rkiinc.com
INSURER(S) AFFORDING COVERAGE NAIC #
Lebanon OR 97355 INSURER A : OHIO SECURITY INS CO 24082
INSURED INSURER B : Ohio Security Ins. CO
Beaver Tree Service Inc INSURER C
270 Wilson Rd INSURER D :
INSURER E :
Central Point OR 97502 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.
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
J COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1000000
_7 CLAIMS-MADE F41 OCCUR PREMISES (Ea occurrence) $ 1000000
MED EXP (Any one person) $ 15000
A BKS 54779670 05/26/2016 05/26/2017 PERSONAL & ADV INJURY $ 1000000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2000000
PRO-
LOC PRODUCTS - COPAP/OP AGG $ 2000000
POLICY F-] ECT
F
OTHER: PKGO1 $
AUTOMOBILE LIABILITY (Ea accident) $ 1000000
ANY AUTO BODILY INJURY (Per person) $
B ALL OWNED SCHEDULED BAS 54779670 05/26/16 05/26/17 BODILY INJURY (Per accident) $
AUTOS AUTOS
NON-OWNED $
HIRED AUTOS AUTOS (Per accident)
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
IDED RETENTION $ $
ORKERS COMPENSATION
ND EMPLOYERS' LIABILITY Y / N STATUTE ER
N / A E.L. EACH ACCIDENT $
NY PROPRIETOR/PARTNER/EXECUTIVE F-1
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) E.L. 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, may be attached if more space is required)
For certificate holders file
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
20 East Main Street
AUTHORIZED REPRESENTATIVE
Ashland, OR 97520~.~ j
1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD