HomeMy WebLinkAboutInsurance Certificate: Central Oregon & Pacific Railroad (4)
ACO DATE (MWDD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 4/30/2015
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 Sand Orr
NAME:
Brown & Brown Northwest PHONE (541) 772-1111 FAX (541)772-3785
A1C No :
3256 Hillcrest Park Drive E-MAIL sorr@bbnw. com
ADDRESS:
INSURERS AFFORDING COVERAGE NAIC #
Medford OR 97504 INSURER A.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 POLICY EFF POLICY EXP LIMITS
LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY (MMIDDIYYYYJ
GENERAL LIABILITY EACH OCCURRENCE $
DAMAGE
COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $
CLAIMS-MADE F-IOCCUR MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $
RO
F LOC $
7 POLICY P
JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
Ea accident $
ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS Per accident
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENT ON $ $
A WORKERS COMPENSATION X TAY IM T OER
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETORIPARTNEWEXECUTIVE ❑ N / A E.L. EACH ACCIDENT $ 1,000,000
OFFICER/MEMBER EXCLUDED? EWC008757 7/1/2014 7/1/2016
(Mandatory in NH) E_L. DISEASE - EA EMPLOYE $ 1,000,000
If yes, describe under Retention - All Other $500,000
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000
Retention - Codes 7539, $750,000
7720 & 7710
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
Re: Permit #CORP150316. 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
Central Oregon & Pacific Railroad, Inc ACCORDANCE WITH THE POLICY PROVISIONS.
.
c/o Genesee & Wyoming Railroad Services,
AUTHORIZED REPRESENTATIVE
13901 Sutton Park Dr South,
Suite 160+
Jacksonville, FL 32224 L •r~-
Sandy OrrJSANDOR
ACORD 25 (2010/05) U 1988-2010 ACORD CORPORATION. All rights reserved.
INS025 (201006).01 The ACORD name and logo are registered marks of ACORD