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