Loading...
HomeMy WebLinkAboutInsurance Certificate: James Fowler C~ DATE (MM/DD/YYYY) ACRD CERTIFICATE OF LIABILITY INSURANCE 9/29/2016 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 endorsements . PRODUCER CONTACT NAME:.. Shelly Donl~_ Woodruff-Sawyer Oregon, Inc. PHONE i IFAX lA 503-243-1815 1001 SW 5th Avenue #1000 o,Ext): E-MAIL Portland OR 97204 ADDRESS: sdonilY@wsandco.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:SAIF Corporation _ 36196 INSURED JAMEWFO-01 INSURER B : James W Fowler CO. INSURER C : 12775 Westview Drive Dallas OR 97338 INSURER D_ INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1835549311 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 ADDLi UBR POLICY EFF_J POLICY EXP LTR TYPE OF INSURANCE ' INSD WVD POLICY NUMBER MM/DDIYYYY MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ r-~ DAMAGE TO RENTED CLAIMS-MADE 171 OCCUR PREMISES Ea occurrence H MED EXP (Any one person) $ 1 PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY I ECOT r LOC PRODUCTS - COMP/OP AGG $ OTHER: L $ AUTOMOBILE LIABILITY _(accc deDtSINGLE LIMIT $ ANY AUTO BODILY INJURY (Per person) $ ~~I AUTOS OWNED SCHEDULED BODILY INJURY (Per accident AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) _ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB AGGREGATE L _ CLAIMS-MADE i DED RETENTION $ $ A WORKERS COMPENSATION 812482 10/1 /2016 10/1/2017 X SPER TATUTE OERH AND EMPLOYERS' LIABILITY _ ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N I E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N / A - - - - (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $1,000,000 1 If yes, describe under DESCRIPTION OF OPERATIONS below I E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Operations of the Named Insured subject to the terms, conditions and exclusions of the policy issued by the Insurance Company. TAP Intertie Booster Pump Station; Project No. 2008-08 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 20 East Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland OR 97520 AUTHORIZED REPRESENTATIVE rd j ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD