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HomeMy WebLinkAboutInsurance Certificate: Dry Creek Landfill 0:x110/2009 Tue 15:21 Wells Fargo Insurance Services ID: #18678 Page l.of 3 I AOORDT. CERTIFICATE OF LIABILITY INSURANCE DATE (0/2D/YYYY) 3/10/2009 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Wells Fargo Insurance Services of Oregon, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 975 Oak Street, Suite 900 Eugene, OR 97401 INSURERS AFFORDING COVERAGE NAIC # INSURED Dry Creek Landfill, Inc. INSURER A Greenwich Insurance Company 22322 PO Box 3187 INSURER B NSUHERc INSURER D Central Point, OR 97502 INSURER 11 COVERAGES 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- AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DD/YY A GENERAL LIABILITY GE0001289406 10/1/2008 10/1/2009 EACH OCCUHHENCL $ 1,000,000 DAMAGE TO RENTED X00,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence CLAIMS MADE a OCCUR M E D EXP Any one person $ 5,000 X $1,000 BI/PD Deduct. PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 2,000,000 LOC F 7 [7 POLICY PRO JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AU lU (Ea accident) $ ALL OWNED ALT DS BODILY INJURY SCHEDULED AU-OS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNS U AU I OS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EAACCIDENT $ ANY AU 10 OTHER THAN EA ACC $ AUTO ONLY AGG $ 1 n A EXCESS/UMBRELLA LIABILITY UE0002127602 10/01/2008 10/01/2009 EACH OCCURRENCE $ 3,01)0,000 X OCCUR F1 CLAIMS MADE AGGREGATE $ 3,000,000 I XDEDUCTIBLE $ RETENTION $ 10,000 $ WC STATU- OTFI WORKERS COMPENSATION AND TORY LIM S EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ ANY PROPRIETOR,/PARTNER/EXECUTIVE OFFICER,/MEMBER EXCLUDED? E1 DISEASE - EA EMPLOYEE $ It yes, describe under SPECIAL PROVISIONS below E L DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS City of Ashland its officers, agents and employees are added as additional insureds. CERTIFICATE HOLDER CANCELLATION Ten Day Notice for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN City of Ashland NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Attn City Administrator IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 20 E Main REPRESENTATIVES. Ashland OR 97520 AUTHORIZED REPRESENTATIVE 0 ACORD 25 (2001/08) 1 W2 423901 O ACORD CORPORATION 1988 0'1/10/2009 Tue 15:21 Wells Fargo Insurance Services ID: #18678 Page 3 of 3 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-S (2001108) 2 of 2 #S915260/M915043