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HomeMy WebLinkAboutInsurance Certificate: Dry Creek Landfill 09/25/2013 12:06:17 PM -0500 FAXCOM PAGE 3 OF 3 263583 DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 9/25/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 'ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES ELOW. 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: PHONE F AlC No Ext): (A/C, NO): Wells Fargo Insurance Services USA, Inc E-MAJL DRESS: 975 Oak Street, Suite 900 INSURER(S) AFFORDING COVERAGE NAIC # Eugene, OR 97401 INSURER A: Greenwich Insurance Company 22322 INSURED INSURER B : XL Specialty Insurance Company 37885 Dry Creek Landfill, Inc. INSURER C : PO Box 3187 INSURER D : INSURER E : Central Point, OR 97502 INSURER F : COVERAGES CERTIFICATE NUMBER: 6615756 REVISION NUMBER: See below 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 POLICYNUMBER MM DDY/YYYY MMLDDMIYY LTR INSR WVD LIMITS A GENERAL LIABILITY GECO03582702 10/1/2013 10/1/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED X 100,000 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS MADE CK OCCUR MED EXP (Any one person) $ 5,000 X $1,000 BI/PD Deduct. PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY JECCT LOC $ AUTOMOBILE LIABILITY COMBINED S NGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accicent) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident B X UMBRELLA LIAB X OCCUR UE0003582502 10/1/2013 10/1/2014 EACH OCCURRENCE $ 3,000.000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 3,000.000 DIED RETENTION $ $ WORKERS COMPENSATION WC STATU OTH- AND EMPLOYERS' LIABILITY Y / N TORY LIMITS ER ANY PROPRIETORlPARTNEWEXECUTIVE ❑ E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, desr_iibe under DESCRIPTICN OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Ashland its officers, agents and employees are added as additional insureds. CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn City Administrator Q \\/J THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN v ACCORDANCE WITH THE POLICY PROVISIONS. E Main ,hland OR 97520 t € AUTHORIZED REPRESENTATIVE S F p 2 2013 I f e ORD name and logo are re i t ark ofACORD © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05)