HomeMy WebLinkAboutInsurance Certificate: Peck Smiley Ettlin Architects _ L
DATE (1~L%V D'YYYYi
CERTIFICATE OF LIABILITY INSURANCE 3/6/2017
THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NO 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 have ADDITIONAL INSURED provisions or 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 conf r rights to the certificate holder in lieu of such endorsements .
PRODUCER CONTACT
NAME:
BROWN&BROWN NOR HWEST/PHS PHONE .ExI): (866) 467-8730 i .Nor. (888) 443-6112
70943V7 P: (866) 467-8730 F: (888) 443-6112 AD E-MAIL
PO BOX 3 3 0 1 5 INSURER(S) AFFORDING COVERAGE NAIC#
SAN ANTONIO TX 78265 INSURERA Hari :r~~ C suaLt r 1I)
INSURED INSURER B =
PECK, SMILEY, ETTLIN ARCHITECTS INC. INSURER C
NED PECK, STEVE SMILLEY, «HANS ETTLIN INSURER D:
4412 SW CORBETT AVE INSURER E:
PORTLAND OR 97239 INSURERF
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 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 jCONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LIVSR TYPE OF17SC; tNCE -4DD SGB POLIC'I":vL-WER POLICYEFT POLICYE_kP LARIS
L TI? A"`" Wt (",1ShLDD/i'YI'Y (V-WD ) 'D'D
COMMERCIAL GENE L LIABILITY EACH OCCURRENCE ; 2, 0 0 0, 0 0 0
CLAIMS-MADE X OCCUR DAMAGE TO RENTED -_M, 000
PREMISES (Ea occurrence)
A X General Z1 b x 5 SBT3. UL7992 04/01/20;7 04/0l/701= MED EXP (Any one person) ;,10r000
PERSONAL a ADV INJURY 2, 000, 000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE -4,000,000
POLICY PRO LOC PRODUCTS - COMPIOP AGG 4, 0 0 0 , 0 0 0
JECT L] ~
OTHER:
AUTOMOBILE LIABILFTY COMBINED SINGLE LIMIT SZ 000, 000
(Ea accident) i
ANY AUTO BODILY INJURY (Per person)
OWNED SCHEDULED SB A U L 7 9 9 2 4 % 0l j Z 017 0 4 !01 BODILY INJURY (Per accident)
AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE
AUTOS ONLY ;AUTOS ONLY (Per accident)
X UMBRELLA UAB X OCCUR EACH OCCURRENCE $1, 00 0, 00 0
A EXCESS LIAR CLAIMS-MADE 5 2 SE. 1 i 7 , 9 ? 4 AGGREGATE 8 1,000,000
DE X RETENTION 0 000
PER OTH-
WORlrF14S 0012PENS.4170N
ANDEMPLOPERS'LIARILITY STATUTE ER
ANY PROPRIETOR,jPARTNMEXECUTIVEY/N E.L. EACH ACCIDENT
OFFICERIMEMBER EXCLUDED? N/A
(Mandatory in NH) F1 E.L. DISEASE- EA EMPLOYEE
If yes, describe under $
DESCRIPTION OF OPERATIONS below E. L- DISEASE -POLICY LIMIT
DESCRIPTION OFOPERATIONS/ LOCATIONS /VEHICPMRD 101, Additional Remarks Schedule, may be attached if more space is required)
Those usual to the Insured's Operations.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE
City of Ashland, It's Officers DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
Employees, an Agents. AUTHORIZED REPRESENTATIVE k
20 East Main treet
Ashland, OR 9 520 7A-Z- / I
(0 1988-2015 ACORD CORPORATION. All rights reserve(
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
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