HomeMy WebLinkAboutInsurance Certificate: Sky LLC
l ® DATE (MM/DD/YYYY)
A!eo CERTIFICATE OF LIABILITY INSURANCE
12/06/2016
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).
CONTACT
PRODUCER N
AME: Ryan J. Birr
PHONE
AIC No Ext : 503-640-6060 (A/C. No503-640-6202
ft-MAIL
DDRESS: ryan@nwinsurance.net
Northwest Insurance Group, Inc. A
3301 NE Cornell Road, Suite R INSURER(S) AFFORDING COVERAGE NAIC #
Hillsboro OR 97124 INSURER A : Atlantic Specialty Insurance Company
INSURED INSURER B :
INSURER C
Sky, LLC INSURER D :
445 Dead Indian Memorial Road INSURER E :
Ashland OR 97520 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 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.
LTR TYPE OF INSURANCE INSp WVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS
✓ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE 91 OCCUR PREMISES Ea occurrence) $
MED EXP (Any one person) $ 5,000
A Y 710018769-0010 11/22/2016 11/22/2017 PERSONAL & ADV INJURY $
GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 1,000,000
POLICY F JECT LOC PRODUCTS - COMPlOP AGG $
OTHER: $
AUTOMOBILE LIABILITY (ECOMBINED SINGLE IMIT
a accident) $
ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS AUTOS
HIREDAUTOS AUTO WNED (PPRUPLRTY DAMAGE
er accident) $
I $
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTIONS $
PER
WORKERS COMPENSATION S
-0 R
TATUTE IT
ER
AND EMPLOYERS' LIABILITY Y I N
ANY PROPRIETORIPARTNER/EXECUTIVE ❑ E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? N/A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Premises Liability limited to designated premises only - 445 Dead Indian Memorial Road, Ashland, OR 97520 - Ashland Municipal Airport
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
-City of Ashland
AUTHORIZED REPRESENTATIVE
20 E. Main Street
Ashland OR 97520 Ryan J. Birr
@ 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD