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HomeMy WebLinkAboutInsurance Certificate: Grayback Forestry Inc Ago CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) tai 12/29/2016 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 endorsements . ONTACT Kendall Pori PRODUCER C NAME: Protectors Insurance, LLC PHONE FAX P.O. Box 4669 . 541-842-2963 (A/C No): 541-772-1906 E-MAIL Medford OR 97504 ADDIR SS! kendallp@protectorsins.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :American States Ins Company 119704 INSURED GRAYB-1 INSURER B :American Economy Insurance Grayback Forestry Inc INSURER C : Western Emergency Services LLC PO Box 838 INSURER D : Merlin OR 97532-0838 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 644644352 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 DDL UBR I POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY 01-CI-311182-80 1/1/2017 1/1/2018 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X❑ OCCUR PREMISES Ea occurrence $1,000,00 X LBFPD MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000_ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,0001000 POLICY a JEC LOC PRODUCTS - COMP/OP AGG $2,000,000 - OTHER: Loggers Broad Form $1,000,000 B AUTOMOBILE LIABILITY 02-CE-228304-50 1/1/2017 1/1/2018 Ea aoadeDtSINGLE LIMIT $1,000,000 X ANY AUTO ! BODILY INJURY (Per person) $ AUTOSNED AUTODULED BODILY INJURY (Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident X Pollution Pollution $1,000,000 A X UMBRELLA LIAB X OCCUR 01 SU417057-80 1/1/2017 1/1/2018 EACH OCCURRENCE $2,000,000 i EXCESS LIAB CLAIMS-MADE AGGREGATE $2,000,000 DED RETENTION $ $ WORKERS COMPENSATION PER 1OTH- AND EMPLOYERS' LIABILITY Y/N STATUTE ER i E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ I DESCRIPTION OF OPERATIONS / LOCATIONS / 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 E Main St ACCORDANCE WITH THE POLICY PROVISIONS. Ashland OR 97520 AUTHORIZED REPRESENTATIVE t " 41'rA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD