HomeMy WebLinkAboutInsurance Certificate: Modular Space Corporation
CERTIFICATE COVERAGE
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c:ifycr:.unty € suranc` services
Named Member or Participant Companies Affording Coverage
City of Ashland COMPANY A . CIS
20 Fast Main Street COMPANY s National Union Fire Insurance Company of Pitts, PA
Ashland, R 97 2 'COMPANY C - RSUI Indemnity
LINES OF COVERAGE
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Company Certificate Effective Termination hype of Coverage Letter Number Date Date Coverage Limit
General Liability A 12LAS , . ? '2 t 2 7,112013 General Aggregate. $15,000,000
X Commercial General IWrability Each Occurrence,
X Public Officials Liability
X Employment Practices
X Occurrence
Auto Liability A 12LA` H 112012 T'l 2013 Genera! Aggregate, None
X Scheduled Autos Each Occurrence: $6,000,000
X Aired Autos
X Non-Owned Autos
! Auto Physical Damage A 12APDA H 7.1,2012 71l!2013
X Scheduled Autos
X Hired Autos
Non-maned Autos
X Property A 12PASH 7! 1/20 12 7/1112013 Per Filed Values
X I eider and Machinery A 12BA H 711/2012 7/11201 Per Filed Values'
X Excess Crime 12ECASH 1.12012 3+ x;2013 Per Less: $250,000
Excess Earthquake
Excess Flo
Excess Cy r Liability
Workers Compensation
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Description, For rental of a 1 Ox32 single-wide mobile office is ui€d€ ng• Unit Number L~g~g .built in 1995 by Blazer Industries, The insufance value is
16,CX This unit will be leased by the City of shun'''.. Pa ks & recreation Department for three months beginning on or abet November : 2012,
as per the agreed ferrrts in the related contract, ModWar Space Corporation is listed as additior°al in
sured on the city's policy for ttwe duration of this
contract. This rental unit mil be located next to the Ashland Pntar= Centennial Ice Rink, 95 Winburn Ways, Ashland, Oregon
C•>XaNCELLAT'(21 N. S d any of t~w coverage do uments he=em be cancelled before the expirabon date
Cer#rfl ate Holder,
flne`ecf. CAS wits p.rov-,: e 3 days An ten notice to the ce°n iuate holde named acrem but flailur to n4l
Modular Space Corporation pase no oh, 4ga1k:,n or fiabilit<i of any ktod upon CIS, i't$ agentS or repeel,~entat wes, or
the ?saver of this, ceri f,~ca t.
t 200 ,Sw~eesf€~rd Road
Berwyn, PA 19312
w ,w.n " < ~...r Date. #',lov nibef 15, 2012