HomeMy WebLinkAboutInsurance Certificate: Modern Building Systems
CERTIFICATE OF COVERAGE
Agent This certificate is issued as a matter of information
DIRECT only and confers no rights upon the certificate holder
other than those provided in the coverage document.
This certificate does not amend, extend or alter the
coverage afforded by the coverage documents listed
herein.
citycounty insurance services
Named Member or Participant Companies Affording Coverage
City of Ashland COMPANY A - Citycounty Insurance Services (CIS)
20 East Main Street COMPANY B - National Union Fire Insurance Company of Pitts, PA
Ashland, OR 97520 COMPANY C - RSUI Indemnity
LINES OF COVERAGE
This is to certify that coverage documents listed herein have been issued to the Named Member herein for the Coverage period indicated. Not withstanding any
requirement, term or condition of any contract or other document with respect to which the certificate may be issued or may pertain, the coverage afforded by the coverage
documents listed herein is subject to all the terms, conditions and exclusions of such coverage documents.
Type of Coverage Company Certificate Effective Termination
Letter Number Date Date Coverage Limit
General Liability A 11 LASH 7/1/2011 7/1/2012 General Aggregate: $15,000,000
X Commercial General Liability Each Occurrence: $5,000,000
X Public Officials Liability
X Employment Practices
X Occurrence
Auto Liability A 11 LASH 7/1 /2011 7/1/2012 General Aggregate: None
X Scheduled Autos Each Occurrence: $5,000,000
X Hired Autos
X Non-Owned Autos
Auto Physical Damage A 11 APDASH 7/1/2011 7/1/2012
X Scheduled Autos
X Hired Autos
X Non-Owned Autos
X Property A 11PASH 7/1/2011 7/1/2012 Per Filed Values
X Boiler and Machinery A 11 BASH 7/1/2011 7/1/2012 Per Filed Values
X Excess Crime B 11 ECASH 7/1/2011 7/1/2012 Per Loss: $250,000
Excess Earthquake
Excess Flood
Workers' Compensation
Description: For rental of a 10x32 mobile office building, Unit #1069, Serial No. 2006.1-12, measuring 320 sq. ft. This unit will be leased by the city
for a minimum of four months beginning on or about November 8, 2011, as per the agreed terms in the Contract for Rental of Mobile Office Building.
Modern Building Systems, Inc., is listed as additional insured on the city's policy for the duration of this contract. This rented unit will be located next
to the Ashland Rotary Centennial Ice Rink, 95 Winburn Way, Ashland, Oregon.
Certificate Holder: CANCELLATION: Should any of the coverage documents herein be cancelled before the expiration date
thereof, CIS will provide 30 days written notice to the certificate holder named herein, but failure to mail
Modern Building Systems, Inc. such notice shall impose no obligation or liability of any kind upon CIS, its agents or representatives, or
9493 Porter Road the issuer of this certificate.
Aumsville, OR 97325
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ate: November 8, 2011