HomeMy WebLinkAboutInsurance Certificate: Lloyd Matthew Haines
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Certificate of Insurance
This certifies that ❑x State Farm Fire and Casualty Company, Bloomington, Illinois
STATE FARM ❑ State Farm General Insurance Company, Bloomington, Illinois
❑ State Farm Fire and Casualty Company, Aurora, Ontario
INSURANCE E] State Farm Florida Insurance Company, Winter Haven, Florida
L E', ❑ State Farm Lloyds, Dallas, Texas
insures the following policyholder for the coverages indicated below:
Policyholder HAINES, LLOYD MATTHEW DBA LLOYD MATTHEW HAINES ATTORNEY AT LAW
Address of policyholder 96 N MAIN ST STE 202 ASHLAND, OR 97520-2792
Location of operations 96 N MAIN ST STE 202 ASHLAND, OR 97520-2792
Description of operations ATTORNEY OFFICE
The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is
subject to all the terms, exclusions, and conditions of those policies. The limits of liability shown may have been reduced by any paid claims.
Policy Period Limits of Liability
Policy Number Type of Insurance Effective Date Expiration Date (at beginning of policy period)
Comprehensive BODILY INJURY AND
97-BZ-4944-6 Business Liability MAR-29-10 APR-02-11 PROPERTY DAMAGE
This insurance includes: X Products - Completed Operations
Contractual Liability Each Occurrence $ 1,000,000.00
X Personal Injury
X Advertising Injury General Aggregate $ 2,000,000.00
X GENERAL LIABILITY
Product - Completed $ 2,000,000.00
Operations Aggregate
Policy Period BODILY INJURY AND PROPERTY DAMAGE
Policy Number EXCESS LIABILITY Effective Date Expiration Date (Combined Single Limit)
❑ Umbrella Each Occurrence $
❑ Other Aggregate $
Policy Period
Effective Date Expiration Date Part I - Workers Compensation - Statutory
Workers' Compensation Part II - Employers Liability
and Employers Liability Each Accident $
Disease - Each Employee $
Disease - Policy Limit $
Policy Period Limits of Liability
Policy Number Type of Insurance Effective Date Expiration Date (at beginning of policy period)
THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY
AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN.
Name and Address of Certification Holder If any of the described policies are canceled before
THE CITY OF ASHLAND, OREGON their expiration date, State Farm® will try to mail a
AND ITS ELECTED OFFICIALS written notice to the certificate holder 30 days
OFFICERS AND EMPLOYEES, AS before cancellation. If we fail to mail such notice, no
THEIR INTERESTS PERTAIN TO THE obligation or liability will be imposed on State Farm or
"HERE WE ARE" TREE SCULPTURE its_agents or representatives.
AND "THE PATH TO JOY AND UNITY" MURALS
20 E MAIN ST _
ASHLAND OR 97520-1814 Signature of Authorized a res ntative
INSURANCE AC( 3 NT REP 03/30/10
Title Date
JON SNOWDEN, STATE FARM AGENT
Agent Name
Telephone Number (541) 482-2461
J. Snowden 37-9A13
Fir, 37
Agent's Code Stam~ ene AFO
Agent Code F473
AFC) Code
1001260 10639910 08-25-2