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HomeMy WebLinkAboutInsurance Certificate: OR Dept of Forestry Procurement Office CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 7/1/2013 F 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: Sandy Orr FAX Beecher Carlson Insurance Agency LLC PHONE (541) 772_1111 A /C No: (541)772-3785 E-MAIL sand orr@beechercarlson.com 3256 Hillcrest Park Drive DRESS: y INSURERS AFFORDING COVERAGE NAIC # Medford OR 97504 INSURER A:Midwest Employers Casualty Co INSURED INSURER B: City Of Ashland INSURER C : 20 E Main St INSURER D: INSURER E : Ashland OR 97520 INSURER F: COVERAGES CERTIFICATE NUMBER:2013-14 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR NS WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE F70CCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMI-- APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY PRO LOC $ ___1 F-IJECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WC STATU- OTH- A WORKERS COMPENSATION X I TORY LIMITS ER_ AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N E L EACH ACCIDENT $ 1 000 00,000 OFFICER/MEMBER EXCLLDED? N/A EW0008757 /1/2013 7/1/2014 (Mandatory in NH) E L DISEASE - EA EMPLOYE $ 1 000 000 If yes, describe under Retention - All Other $500,000 DESCRIPTION OF OPERPTIONS below E.L DISEASE -POLICY LIMIT $ 1,000,000 Retention - Codes 7539, $750,000 7720 & 7710 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) American Recovery & Reinvestment Act Funded Program Grant between ODF and Ashland Parks Department. CERTIFICATE HOLDER CANCELLATION poverhulser@ odf . state . or . u SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Oregon Department of Forestry Procurement Office Attn : Pam Overhulser, Grant Operations C AUTHORIZED REPRESENTATIVE 2600 State Street Salem, OR 97301 fA Sandy Orr/SANDOR -G/ E'~'vL- ACORD 25 (2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS026 (2o1oo5).o1 The ACORD name and logo are registered marks of ACORD