HomeMy WebLinkAboutInsurance Certificate: Table Rock Masonry
WORLD OF INS LLC PR494GREll/UE"
1091 MEDFORD CENTER COMMERC/AL
MEDFORD, OR 97504
Policy number: 03976300-0
Underwritten by:
Artisan and Truckers Casualty Co
Insured: EFREN REGALADO
CITY OF ASHLAND November 23, 2016
20 E MAIN Policy Period: Nov 4, 2016 - Nov 4, 2017
ASHLAND, OR 97520
Mailing Address
Artisan and Truckers Casualty Co
PO Box 94739
Additional insured endorsement Cleveland, OH 44101
1-800-444-4487
For customer service, 24 hours a day,
Name of Person or Organization 7 days a week
CITY OF ASHLAND
20 E MAIN
ASHLAND, OR 97520
The person or organization named above is an insured with respect to such liability coverage as is
afforded by the policy, but this insurance applies to said insured only as a person liable for the conduct of
another insured and then only to the extent of that liability. We also agree with you that insurance
provided by this endorsement will be primary for any power unit specifically described on the
Declarations Page.
Limit of Liability
Bodily injury Not applicable
Property Damage Not applicable
Combined Liability $1,000,000 each accident
All other terms, limits and provisions of this policy remain unchanged.
This endorsement applies to Policy Number: 03976300-0
Issued to (Name of Insured): EFREN REGALADO
TABEL ROCK MASONRY
Effective date of endorsement: 11/22/2016 Policy expiration date: 1110412017
Form 1198 (Oil/04)