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HomeMy WebLinkAboutInsurance Certificate: Small Woodland Services OP ID: KMI ACORL7►' DATE (MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 03/05/12 FTHIS 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 endorsements . PRODUCER 541-773-5358 NAME: CONTACT Terry Friend Protectors Insurance, LLC PHONE FAX Pilot Rock Ins Agency LLC (CA) 541-772-1906 c : 541-773-5358 A<C No :541-772-1906 PO Box 4669 EADDRESS: -MAIL terryf@protectorsins.com Medford, OR 97501 PRODUCER Karol M. Igou mSMALL-2 INSURERS AFFORDING COVERAGE NAIC # INSURED Small Woodland Services Inc INSURER A : SAI F Corporation Martin L Main INSURER B: Philadelphia Insurance Comp. 2799 Camp Baker Road INSURER C : Medford, OR 97501 INSURER D INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED B X COMMERCIAL GENERAL LIABILITY X PGA004000 07/01111 07/01/12 P REMISES (Ea occurrence) $ 100,00 CLAIMS-MADE a OCCUR MED EXP (Anyone person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 X Forestr E&O $1mil PGA004000 07/01/11 07/01/12 GENERAL AGGREGATE $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,00 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ B X HIRED AUTOS PGA004000 07/01111 07/01112 (Per accident) B X NON-OWNED AUTOS PGA004000 07/01/11 07/01/12 $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC STATU- 10TH- AND EMPLOYERS' LIABILITY TORY LIMITS ER A ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑ 433755 01/01/11 01/01/12 E.L. EACH ACCIDENT $ 500,00 OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ 500,00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) It is agreed and understood that the certificate holder is named as additional insured but only with respect to its liability arising out of the activities of the named insured CERTIFICATE HOLDER CANCELLATION CITYASH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Ashland Fire & Rescue ACCORDANCE WITH THE POLICY PROVISIONS. 455 Siskiyou Blvd Ashland, OR 97520 AUTHORIZED REPRESENTATIVE Karol M. Igou ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD