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HomeMy WebLinkAboutInsurance Certificate: Pacific Mobile Structures Client: 704959 PACIFMOB ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMMDNYM 10/30/2014 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: U51 Northwest CL1 c°ONH Ext ; 503 224-8390 ' No ; 610 362-8130 INC. ) 700 NE Multnomah, Suite 1300 E-MAIL ADDRESS: angela.christiansen@usi.biz Portland, OR 97232 INSURER(S) AFFORDING COVERAGE NAIC # 503 224-8390 INSURER A : American Economy Insurance Comp 19690 INSURED INSURER B : American Insurance Company 21857 Pacific Mobile Structures Inc INSURER C : Liberty Northwest Insurance Cor 41939 P.O. Box 1404 INSURER D : 1554 Bishop Rd. INSURER E Chehalis, WA 98532 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 CONTRACTOR 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. EXCLUSION'S AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER [M_MJDDIYYYY)_ (MMlDDIYYYY LIMITS A GENERAL LIABILITY 01013183905 113112014 01/311201 EAgqC~~HgqOCCURRENCE $1,000,000 X C061MERCIAL GENERAL LIABILITY PREttIfSES (Ea occwr nce 5200,000 CLAIMS-MADE FXIOCCUR MED EXP (Any one person) $10,000 -X WA Stop Gap $1 MM PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPtOP AGG 52,000,000 POLICY X JECOT X LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident _ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED BODILY INJURY (Per accident) S AUTOS AUTOS NON-OWNED P OPERTY DAMAGE $ HIRED AUTOS AUTOS B X UMBRELLA LIAB X OCCUR SU048773568 1/3112014 01/31/201 EACH OCCURRENCE s5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED RETENI ION $ $ C WORKERS COMPENSATION WC41NCO18531 113112014 01131/2015X WC STATU- ER AND EMPLOYERS' LIABILITY TORY LIMIT YIN ANY PROPRIETORMARTNERIEXECUTIVE E.L. EACH ACCIDENT $1,000,000 _ OFFICERIMEMBER EXCLUDED? N NIA (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE S1,000s000 If yes, OESCR PT10 O OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 _ A installation 01013183905 113112014 01131/201 $1,000,000 $1,000 Ded DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space Is required) The City of Ashland, Oregon, and its elected officials, officers and employees are additional insured as respects the operations of the named Insured. CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 East Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE. ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S136301381M11649285 ADCJT