HomeMy WebLinkAboutInsurance Certificate: Pacific Mobile Structures (3)
CERTIFICATE OF COVERAGE
Agent This certificate is issued as a matter of information only
DIRECT and confers no rights upon the certificate holder other
than those provided in the coverage document. This
certificate does not amend, extend or alter the coverage
afforded by the coverage documents listed herein. 4D
citycounty insurance services
Named Member or Participant Companies Affording Coverage
City of Ashland COMPANY A -CIS
COMPANY B - National Union Fire Insurance Company of Pitts, PA
20 East Main Street COMPANY C - RSUI Indemnity
Ashland, OR 97520 COMPANY D - Torus National Insurance Company
LINES OF COVERAGE
This is to certify that coverage documents listed herein have been issued to the Named Member herein for the Coverage period indicated. Not withstanding any
requirement, term or condition of any contract or other document with respect to which the certificate may be issued or may pertain, the coverage afforded by the coverage
documents listed herein is subject to all the terms, conditions and exclusions of such coverage documents.
Type of Coverage Company Certificate Effective Termination Date Coverage Limit
Letter Number Date
General Liability A 16LASH 7/112016 7/1/2017 General Aggregate: $15,000,000
X Commercial General Liability Each Occurrence: $5,000,000
X Public Officials Liability
X Employment Practices
X Occurrence
Auto Liability A 16LASH 7/1/2016 7/1/2017 General Aggregate: None
X Scheduled Autos Each Occurrence: $5,000,000
X Hired Autos
X Non-Owned Autos
Auto Physical Damage A 16APDASH 7/1/2016 7/1/2017
X Scheduled Autos
X Hired Autos
X Non-Owned Autos
X Property A 16PASH 7/1/2016 7/1/2017 Per Filed Values
X Boiler and Machinery A 16BASH 7/1/2016 7/1/2017 Per Filed Values
Excess Liability
X Excess Crime B 16ECASH 7/1/2016 7/1/2017 Per Loss: $250,000
X Excess Earthquake C 16EQASH 7/1/2016 7/1/2017 Each Occurrence: $5,000,000
X Excess Flood C 16FASH 711/2016 7/1/2017 Each Occurrence: $5,000,000
X Excess Cyber Liability A 16ECLASH 7/1/2016 7/1/2017 Occurrence/Aggregate: $500,000
Workers' Compensation
Description: Per contract for rental of one 10' x 30' mobile office for use by the City of Ashland Parks and Recreation Department at 95 Winburn Way,
in Ashland, Oregon. Pacific Mobile Structures, Inc., is named as additional insured for general liability and loss payee on the leased mobile Unit
#998994, Serial #998994, Lease #45933.
Certificate Holder: CANCELLATION: Should any of the coverage documents herein be cancelled before the expiration date
thereof, CIS will provide 30 days written notice to the certificate holder named herein, but failure to mail such
Pacific Mobile Structures notice shall impose no obligation or liability of any kind upon CIS, its agents or representatives, or the issuer
13970 Fir Street of this certificate.
Oregon City, OR 97045
Date: November 3, 2016