HomeMy WebLinkAboutInsurance Certificate: Central Oregon & Pacific Railroad (3)
~ p c ~y DATE (MMIDDIYYYY)
CERTIFICATE OF LIABILITY INSURANCE 3/5/2015
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 Sandy Orr
NAME:
Brown & Brown Northwest PHONE . (541) 772-1111 A/C No : (541) 772-3785
3256 Hillcrest Park. Drive E" tiR . sorr@bbnw. com
iNSURER S AFFORDING COVERAGE NAiC #
Medford OR 97504 INSURERA Midwest Employers Casualty Co 3612
INSURED INSURER B :
City Of Ashland INSURER C :
20 E Main St INSURER D :
INSURER E :
Ashland OR 97520 INSURER F :
COVERAGES CERTIFICATE NUMBER:14-15 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 ADDLSUBR POL)CY EFF POLICY EXP LIMITS
LTR TYPE OF INSURANCE POLICY NUMBER MM/DDIYYYY MM/DD/YYYY
GENERAL LIABILITY EACH OCCURRENCE S
DAMAGE RENTED
COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence S
CLAIMS-MADE F__1OCCUR MED EXP (Any one person) $
PERSONAL & ADV INJURY S
GENERAL AGGREGATE S
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP ,AGG S
RO- LOC S
-1 POLICY P
JECT
COMBINED SINGLE LIMIT
AUTOMOBILE LIABILITY Ea accident S
ANY AUTO BODILY INJURY (Per person) S
ALL OWNED SCHEDULED BODILY INJURY (Per accident) S
AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE $
{Per accident)
HIRED AUTOS AUTOS
$
UMBRELLA LIAR HOCCUR EACH OCCURRENCE S
EXCESS LIAR CLAIMS-MADE AGGREGATE S
DED RETENTION 5 S r- STATU A WORKERS COMPENSATION T! RY L IM T OT
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑ E.L. EACH ACCIDENT $ 1 000,000
OFFICER/MEMBER EXCLUDED? NIA EWC008757 7/1/2014 7/1/2015
(Mandatory in NH) E.L. DISEASE - EA EMPLOYE S 1,000,000
If yes, describe under Retention - All Other $500,000
DESCRIPTION of OPERATIONS below E.L. DISEASE - POLICY LIMIT S 1,000,000
Retention - Codes 7539, $750,000
7720 & 7 710
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
Re: RR Project#13CORP06R. Waiver of Subrogation by Written Contract per endorsement ISI-265 (8/13)
attached.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Central Oregon & Pacific Railroad, Inc.
c/o Genesee & Wyoming Railroad Services,
13901 Sutton Park Drive South AUTHORIZED REPRESENTATIVE
Suite 345C
Jacksonville, FL 32224 }.id•
Sandy Orr/SANDOR
ACORD 25 (2010/05) O 1988-2010 ACORD CORPORATION. All rights reserved.
INS025 (201005).01 The ACORD name and logo are registered marks of ACORD