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HomeMy WebLinkAboutInsurance Certificate: Regenesis Ecological Design Policy Number: Date Entered: 06/21/2016 A~"RQ~ DATE (MMiDD!YYYY) CERTIFICATE OF LIABILITY INSURANCE 6/21/2016 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). IRODUCER CONTACT Massingill Harmon Insurance Agency NAME: - 2012 N Rosa Parks Way A oN No EXtI. (503) 286-7702 A_c~No : (503) 445-0150 E-MAIL kevin@harmoninsurance.com Portland, OR 97217 ADDRESS! INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Mid-Century Insurance Company NSURED Regenesis Ecological Design INSURER B : INSURER C : 426 A ST Suite 102 INSURER D : Ashland, OR 97520 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 A SUBR POLICY EFF POLICY EXP T LIMITS LTR ! IN D'. WVDI POLICY NUMBER MMiDD/YYYY MM/DDYYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S _ DAMAGE TO RENTED g CLAIM1vtS-MADE OCCUR ` PREJM)SES !Ea occurrence)- - - - MED EXP.,%,- one person) I PEPS-3'<r,_ J +RY ! S N'L AGGREGATE LIMIT APPLIES PER- I GENEP' _ GE - POLICY PRO _ i PROD -S - - OTHER: AUTOMOBILE LIABILITY COP.aBI JEL S iEa ac ;ae _ - S ANY AUTO BODILY - ALLOWNED E^ _ _ AUTOS BODILY acc~denti 5 HIRED AUTOS - Per acctce- S UMBRELLA LIAB v Jv _ CC = L= EXCESS LIAB - WORKERS COMPENSATION j PAP T AND EMPLOYERS' LIABILITY ~TAT'uTc I R~_ - Y N; INV PROPRIETCR PARTNER EXECU T i~/E E.L EACH ACCIDENT _ S 500, 000 A - - EXCLUDE-D' Y N A A03148801 8/37/2016 8/31/2027 (Mandatory in NH) 500, 000 500 000 DESCRIPTION OF OPERATIONS, LOCATIONS VEHICLES (ACORD 101. Additional Remarks Schedule. may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION City of Ashland Public Works Department 20 E Main ST SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE Kevin P Harmon ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Produced using Forms Boss Plus software. Va:v✓.FormsBoss. coin, impressive Publishing 800-208-1977