Loading...
HomeMy WebLinkAboutInsurance Certificate: Pacific Mobile Structures (2) PACIF35 OP ID: RS CERTIFICATE OF LIABILITY INSURANCE 0 DA1/14/201 Y) 01114/209 4 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). CONTACT PRODUCER Phone: 360-736-7601 N AME, Nicholson & Associates - 118 W. Pine Street Fax: 360-330-0970 (A"CNN . Fixt _ c Ito : Centralia, WA 98531-4290 E-MAIL Todd Working ADDRESS: _ INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: American States Insurance Co, 19704 INSURED Pacific Mobile Structures, Inc INSURERS: Attn: Nick Ververls P.O. Box 1404 INSURER C Chehalis, WA 98532 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 NTH 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 CONCITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR - - DD BR POLIO F POLICY EXP - LTR TYPE OF INSURANCE lam POLICY NUMBER MMIDDIYYYY MMiDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY O RENTE-O PREMISES {Ea ocowrence) S CLAIMS-MADE OCCUR MED EXP (Any one person) S PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ PRO- POLICY LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident . 1,000,00 A X ANY AUTO X 01 C13162926 0113112014 01131/2015 BODILY INJURY (Per person) $ AUTOS ALLOWNED _ AUTOS SCHEDULED BODILY INJURY (Per accident) $ NON-OWNED 'PROPERTY DAMA0E___ _ HIREDAUTOS AUTOS Pe{accident $ 1,000,00 S UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE 5 DED RETENTI DN $ $ WORKERS COMPENSATIOV V U C STATU OTH- AND EMPLOYERS' LIABILITY Y I N T LIMIT I E-R - _ _ ANY PROPRIETORIPARTNER/EXECUTIVE E-L. EACH ACCIDENT $OFFICERIMEMBER EXCLUCED7 NIA (Mandatory In NMI E.L. DISEASE - EA EMPLOYE $ If yes describe under - DESG'RiPTION OF OPERATIONS Wow E-L. DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) City of Ashland, Oregon, and its elected officials, officers and employees as additional insured with respects to auto liability. Coverage is primary and non contributory. Job located at 95 WJ,nburn Way Ashland, OR 97520 CERTIFICATE HOLDER CANCELLATION CITY059 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main St Ashland, OR 97520 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010105) The ACORD name and logo are registered marks of ACORD