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HomeMy WebLinkAboutInsurance Certificate: Rogue Waste Systems 09/22/2011 10:49:52 AM -0700 FAXCOM PAGE 3 OF 3 IYYYY) ACS CERTIFICATE OF LIABILITY INSURANCE 9 DAT/22/2O01 , /22/2 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 NAME: PHONE TFAX Wells Fargo Insurance Services USA, Inc A~~No Exti_ No): ADDRESS: 975 Oak Street, Suite 900 PRODUCER - - - CUSTOMER ID ROGUE WAS' Eugene, OR 97401 IN AFFORDING COVERAGE NAIC # INSURED INSURER A : Everest National Insurance Company 10120 Rogue Waste Systems, LLC INSURER 8 : SAIF Corporation 36196 PO Box 3187 INSURER C : INSURER D : Central Point, (DR 97502 INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER: 3278776 REVISION NUMBER: See below 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 TYPE OF INSURANCE POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER MMIDD(YYYY MMIDDIYYYY ! LIMITS GENERAL LIABILITY 1,000,000 A I 72SW000497101 ~I 10/1 /2010 10/1/2011 EACH occuRRE-NCE ~ $ X COMMERCIAL GENE RAIL L IABIL ITY 'REMISES (Ea occurrence $ 100,000 - - CLAIMS-MADE X OCCUR MEDEXP(Any onepwson) $ 5,000 X $1,000 BI/PD Daduct PERSONAL R ADV INJURY $ 000,000 I ~E N' 4= 2,000,000 C RA_ AGGREGATE $ GENT AGGREGATE LIMITAPPI IES PER PRO)OCTS -COMP/OP AGO ~ $ 2,000,000 POLICY PRO- LOC $ JE C A AUTOMOBILE LIABILITY 72SW000497101 1 101112010 10/1/2011 COMBINED SINGLE LIMIT j (Ea accident) $ 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AU TO`' BOOIL Y INJURY (Per accident) $ SCHEDULED AUTO'i PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON~OWNED AUTCS $ $ i UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS {VADE AGGREGATE $ H DEDUCTIBLE ~ I $ RETENTION $ $ WORKERS COMPENSATION X WC S~A U OTN-L~l B AND EMPLOYERS' LIABILITY 519473 101112010 1011/2011~0vM Ts_ ER Y N I F t EACH ACC DEN' $ 500,000 ANY PROPRIETORJPARTNER/EXECUTIVE OFFICERIMEMBEREXCLIJOEO~ !NIA' - (Mandatory in NH) EL 1)1-,EASE - EA -MPi-OYES $ 500,000 f yes, descdbe under DESCRIPTION OF OPERATIONS below E L OISi:ASE -POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, ifmore space is required) The City of Ashland, Oregon and its elected officials, officers and employees are listed as additional insureds but only with respects to the services provided by Rogue Shred, LLC. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main St. Ashland, OR 97502 AUTHORIZED REPRESENTATIVE (Thiscertilicaterep'acescertfcate#24s44791ssuedon 3/16/201•) © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD