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HomeMy WebLinkAboutInsurance Certificate: Cycle Oregon /17/2009YI ACORDCERTIFICATE OF LIABILITY INSURANCE 3DATE PRODUCER (641) 842-2135 FAX: (641) 828-2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 4cKay Insurance Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 106 East Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P O Box 151 Knoxville IA 50138 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Philadelphia Insurance Cycle Oregon, Inc INSURER B: 2124 N. Flint INSURER C: INSURER D: Portland OR 97227 INSURER E: OVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING AN 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. INSR ADD-1-1 POLICY EFFECTIVE POLICY EXPIRATION LIMITS T INSRDI TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DD/YY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 $ 100 , 000 X COMMERCIAL GENERAL LIABILITY PREMAISES (Ea RENTED A CLAIMS MADE a OCCUR PHPK386374 4/1/2009 4/1/2010 MEDEXP An one person) $ 0 PERSONAL s ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 3,000,000 PRO LOC F X POLICY JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 ANY AUTO A ALL OWNED AUTOS PHPK386374 4/1/2009 4/1/2010 BODILY INJURY X SCHEDULED AUTOS (Per person) $ 1,000,000 X HIRED AUTOS BODILY INJURY $ X NON-0WNEC AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA A $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 1,000,000 -1 OCCUR FICLAIMS MADE AGGREGATE $ 1,000,000. $ A DEDUCTIBLE PHUB263156 4/1/2009 4/1/2010 $ X RETENTION $ 10 , 000 $ WC STATU- OTH- WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Ashland EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Diane Shiplet 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT 20 E Main Street FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE Ashland, OR 97520 INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Dan McKay/JODI ACORD 25 (2001/08) © ACORD CORPORATION 1988 IWCA7r, in+nON nO., pJnO 1 of 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 (2001/08) Page 2 of 2 INS025 pio8).o8a