HomeMy WebLinkAboutInsurance Certificate: Pacific Mobile Structures (3)
CERTIFICATE OF COVERAGE
Agent This certificate is issued as a matter of information only
and confers no rights upon the certificate holder other
than those provided in the coverage document. This
DIRECT certificate does not amend, extend or alter the coverage
afforded by the coverage documents listed herein. 4D
citycounty insurance services
Named Member or Participant Companies Affording Coverage
City of Ashland COMPANY A - CIS
20 East Main Street COMPANY B - National Union Fire Insurance Company of Pitts, PA
Ashland, OR 97520 COMPANY C - RSUI Indemnity
LINES OF COVERAGE
This is to certify that coverage documents listed herein have been issued to the Named Member herein for the Coverage period indicated. Not withstanding any
requirement, term or condition of any contract or other document with respect to which the certificate may be issued or may pertain, the coverage afforded by the coverage
documents listed herein is subject to all the terms, conditions and exclusions of such coverage documents.
Type of Coverage Company Certificate Effective Termination Date Coverage Limit
Letter Number Date
General Liability A 14LASH 7/1/2014 7/1/2015 General Aggregate: $15,000,000
X Commercial General Liability Each Occurrence: $5,000,000
X Public Officials Liability
X Employment Practices
X Occurrence
Auto Liability A 14LASH 7/1/2014 7/1/2015 General Aggregate: None
X Scheduled Autos Each Occurrence: $5,000,000
X Hired Autos
X Non-Owned Autos
Auto Physical Damage A 14APDASH 7/1/2014 7/1/2015
X Scheduled Autos
X Hired Autos
X Non-Owned Autos
X Property A/C 14PASH 7/1/2014 7/1/2015 Per Filed Values
X Boiler and Machinery A 14BASH 7/1/2014 7/1/2015 Per Filed Values
X Excess Crime B 14ECASH 7/1/2014 711/2015 Per Loss: $250,000
Excess Earthquake
Excess Flood
Excess Cyber Liability
Workers' Compensation
Description: Pacific Mobile Structures, Inc. is named as additional insured for general liability and loss payee on the leased mobile unit, Order
Confirmation #94664.3, Unit # 05032, Serial Number 05032.
Certificate Holder: CANCELLATION: Should any of the coverage documents herein be cancelled before the expiration date
thereof, CIS will provide 30 days written notice to the certificate holder named herein, but failure to mail
Pacific Mobile Structures, Inc. such notice shall impose no obligation or liability of any kind upon CIS, its agents or representatives, or the
P.O. Box 1404 issuer of this certificate.
Chehalis, WA 98532
(360) 748-0121
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~"'``mate: October 31, 2014