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HomeMy WebLinkAboutInsurance Certificate: JM Construction (2) Client#: 176828 JMCONS3 ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/01/2016 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 CONTACT NAME: Therese Pritchett Propel Insurance PHONE FAX Medford Workers Compensation (A/c, No, Ext :800 499-0933 A/c, No :866 577-1326 P O Box 936 -ADDRESS: therese.pritchett@propelinsurance.com - INSURER(S) AFFORDING COVERAGE NAIC # Medford, OR 97501 INSURER A : SAIF Corporation 36196 INSURED INSURER B : JM Construction, Inc. JM Trucking DBA INSURER C: INSURER D P O Box 1637 Shady Cove, OR 97539 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. LTRR TYPE OF INSURANCE ADDL SUBR!, POLICY EFF POLICY EXP INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE F- OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ F-7 PRO- POLICY I I JECT F1 LOC PRODUCTS - COMP/OP AGG $ OTHER: $ COMBINED AUTOMOBILE LIABILITY ( Ea acciden SINGLE LIMIT $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NONNOSWNED PROPERTY DAMAGE $ (Per accident } $ UMBRELLA LIAR - _ ' EACH EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MAD AGGREGATE $ $ DED RETENTION $ WORKERS COMPENSATION PER OTH- A AND EMPLOYERS' LIABILITY Y / N 948875 12/01/2016 12/01/2017 TEAR TE X ER ANY PROPRIETOR/PARTNER/EXECUTIVE f-7 N/A E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCl.l1DFD? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $1,000,000 If yes, describe under E.L. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 E. Main St. ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520-1814 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 #S2463441 /M2458524 LAH00