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HomeMy WebLinkAboutInsurance Certificate: Rogue Waste Systems LLC Client#: 1137013 ROGUEWAS ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 9/27/2016 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 NAME: NE: Teresa Weston USI Northwest (A/CC, o, E541 685-5300 is , No 975 Oak Street, Suite 900 ASS: teresa.weston@usi.com _ Eugene, OR 97401 INSURER(S) AFFORDING COVERAGE NAIC # 541 685-5300 _ INSURER A : Greenwich Insurance Company 22322 INSURED INSURER B : XL Specialty Insurance Company 37885 Rogue Waste Systems LLC INSURER c : SAIF Corporation 36196 One West Main St., Suite 401 INSURER D : Medford, OR 97501 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 CONTRACTOR 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DDIYYYY MM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY GE0003582705 10/01/2016 10/01/201 EACH OCCURRENCE $1,000,000 CLAIMS-MADE OX OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $100,000 X BI/PD_ Ded: $1,00 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $ 2,000,000 PRO- PRODUCTS - COMP/OP AGG $2,000,000 JECT LOC POLICY OTHER: $ AUTOMOBILE LIABILITY AE0003582405 10/0112016 10/01/201 COMBINED SINGLE LIMIT 1,000,000 A Ea accident $ BODILY INJURY (Per person) $ X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ _ NON-OWNED PROPERTY DAMAGE , $ HIRED AUTOS AUTOS Per accident $ B LX UMBRELLA LIAB X OCCUR UE0003582505 10/01/2016 10/01/201 EACH OCCURRENCE $110001000 EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000, 000 DED X RETENTION $$10,000 $ - 07 - PER WORKERS COMPENSATION OTH- C' AND EMPLOYERS' LIABILITY 519473 10/01/2016 10/01/2017 TA T R ANY PROPRIETOR/PARTNERIEXECUTIVE Y I N E.L. EACH ACCIDENT $1 000,000 OFFICER/MEMBER EXCLUDED? L NIA j (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $1,000,000 If yes, describe under j DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 I i DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Ashland, Oregon and its elected officials, officers and employees are listed as additional insureds but only with respects to the services provided by Rogue Shred, LLC. CERTIFICATE HOLDER CANCELLATION CI of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 East Main St. ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97502-0000 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD #S18972770/Ml 8970280 PBKZP