HomeMy WebLinkAboutInsurance Certificate: ODOT Access & Utility Permit Unit
City"County Insurance Services CERTIFICATE OF COVERAGE Rev. 717/05
Agent This certificate is issued as a matter of information only and confers no rights upon the
Wilson Heirgood Associates certificate holder other than those provided in the coverage document. This certificate
does not amend, extend or alter the coverage afforded by the coverage documents listed
2930 Chad Drive herein.
Eugene, OR 97408-7382
Companies Affording Coverage
Named Member or Participant COMPANY A - City County Insurance Services (CIS)
City of Ashland COMPANY B - National Union Fire Insurance co. of Pittsburgh, PA
20 East Main Street COMPANY C - RSUI Indemnity
Ashland, OR 97520
COVERAGES
This is to certify that coverage documents listed herein have been issued to the Named Member herein for the Coverage period indicated. Not withstanding any requirement, term
or
condition of any contract or other document with respect to which the certificate may be issued or may pertain, the coverage afforded by the coverage documents listed herein is
subject
to all the terms, conditions and exclusions of such coverage documents.
CO Type of Coverage Certificate # Effective Expiration Limits
LT Date Date
A General Liability 06LASH 7/1/2006 7/1/2007 General Aggregate $3,000,000
X Commercial General Liability Each Occurrence $1,000,000
X Public Officials Liability
X Employment Practices
X Occurrence
A Auto Liability 06LASH 7/1/2006 7/1/2007 General Aggregate None
X Scheduled Autos Each Occurrence $1,000,000
X Hired Autos
X Non-Owned Autos
A Auto Physical Damage 06APDASH 7/1/2006 7/1/2007
X Scheduled Autos
X Hired Autos
X Non-Owned Autos
A X Property 06PASH 7/1/2006 7/1/2007 Per Filed Values
A X Boiler and Machinery 06BASH 7/1/2006 7/1/2007 Per Filed Values
B Excess Crime
C Excess Earthquake
C Excess Flood
A Workers' Compensation
escription: Certificate holder is listed as additional insured in regards to excavation work regarding a sanitary
ewer repair to be done on Rogue Valley Highway 99 - Lithia Way, which is in ODOT's right of way. Location is
etween or near North Second Street and North First Street in Ashland, Oregon. Project to be completed between
he dates of March 2007 and May 2007.
Certificate Holder CANCELLATION: Should any of the coverage documents herein be cancelled before the expiration date
Oregon Dept. of Transportation thereof, CIS will provide 30 days written notice to the certificate holder named herein, but failure to mail
such notice shall impose no obligation or liability of any kind upon CIS, its agents or representatives, or the
Access & Utility Permit Unit issuer of this certificate.
800 Airport Road
Salem, OR 97310
By: ~4. Date: Feb. 21,2007