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Home My WebLink AboutInsurance Certificate: Pacific Mobile Structures PACIF35 OP ID: RS CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 01 /19/2017 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 Todd Working Nicholson & Associates PNAME: 21g, 118 W. Pine Street AEXt : 360-736-7601 Centralia, WA 98531-4290 E-MAIL _ (AA/c,No): 360-330-0970 Todd Working ADDRESS: _ INSURER(S) AFFORDING COVERAGE NAIL # INSURER A: American Fire & Casualty Ins INSURED Pacific Mobile Structures Inc INSURER B : l Attn: Nick Ververis PO Box 1404 INSURER C: L Chehalis, WA 98532 INSURER D INSURER E : i INSURER F : 1 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. INSR DL SSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD IWVD ( POLICY NUMBER I'MM/DD/YYYY MM/DD I UMlTS IYYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 15 DAMA T RENTED CLAIMS-MADE OCCUR i I PREMISES Ea occurrence) ~ S I( I MED EXP (Any one person) S 1 ( PERSONAL & ADV INJURY S GEN L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S POLICY L! PRO- E LCC ! I j JECT I I PRODUCTS - COMP/OP AGG i S I OTHER: ( 1 S AUTOMOBILE LIABILITY I I I COMBINED SINGLE LIMIT I S 1,000,000 A X (Ea accident ANY AUTO X IBAA55555944 1 01/31/20171 01/3112018 BODILY INJURY (Per person) S ALL OWNED F SCHEDULED AUTOS AUTOS i I BODILY INJURY (Per accident) S H NON-OWNED PROPERTY DAMA HIREDAUTOS AUTOS I GE S ( Per accident IS UMBRELLA LIAB j OCCUR I ~ EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE I S DED RETENTION S i I S WORKERS COMPENSATION I PER OTH- AND EMPLOYERS' LIABILITY Y I N STATUTE ER ANY PROPRIETORlPARTNER/EXECUTIVE I E.L. EACH ACCIDENT j S OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) ! I ( E.L. DISEASE - EA. EMPLOYE S If yes, describe under DESCRIPTION OF_ OPERATIONS below I E.L. DISEASE - POLICY LIMIT I s . i DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Ashland, Oregon, and its elected officials, officers and employees as additional insured with respects to auto liability. Coverage is primary and non contributory. Job located at 95 Winburn Way Ashland, OR 97520 CERTIFICATE HOLDER CANCELLATION CITY059 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main St Ashland, OR 97520 AUTHORIZED REPRESENTATIVE 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD