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HomeMy WebLinkAboutInsurance Certificate: Field Transportation 1 10/31/2016 09:51 c~tksl Page 1/1 ACo ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) `66.~ 10/31/2016 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 COCT NAME. Customer Service Team Choice One Insurance PHONE (503) 387-5211 FAX A/C No E AIC No): (503)387-5750 9111 SE Saint Helens St EMAIL customer service@choiceoneinsurarnceinc.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # Clackamas OR 97015 INSURERA:United States Liability Ins Co 25895 INSURED INSURER B Northland Insurance Company 24015 Field Transportation, Inc INSURERC : 10815 SW 135th INSURER D INSURER E Beaverton OR 97008 INSURER F: COVERAGES CERTIFICATE NUMBER:AL/GL/MTC 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 POLICY EFF POLICY EXP LTR POLICY NUMBER (MMIDOrrrM LMMIDONYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS MADE o OCCUR PRDAMAGE TO RENTE17- EMISES Ea occurrence $ 100, 000 IMS2726525 3/15/2016 3/15/2017 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 M'OTHER' L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 2, 000, 000 POLICY a EC o LOC PRODUCTS - COMP/OP AGG Included $ AUTOMOBILE LIABILITY Ea BNEnt SINGLE LuNI $ 1,000,000 B ANY AUTO BODILY INJURY (Per person) $ ALL OWNED X AUTOSULED HH185050 3/1512016 3/15/2017 BODILY INJURY (Per accident) $ NON-OWNED PROPERTY DAMA E HIRED AUTOS AUTOS Per accident $ Uninsured motonst combined $ 100,000 UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIA8 CLAIMS-MADE AGGREGATE $ IDED RETENTION $ $ WORKERS COMPENSATION PEAT EMPLOYERS' LIABILITY Y I N STATUTE ER ANY PROPRIE T OR/PARTNER/E>ECUTIVE E .L EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ If s, describe under DESCRIPTION OF OPERATIONS below E.L DISEASE - POLICY LIMIT $ B Motor Truck Cargo VU185050 3/1512016 3/15/2017 Single Conveyanc"75,000 Deduct/1, 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 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 Andrey Shulik/PAAiV ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401)