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HomeMy WebLinkAboutInsurance Certificate: Hooper Springs Tree Service AC R ~ ~ CERTIFICATE OF LIABILITY INSUF~~;ANCE DATE(MMIDDlYYYY) 05!1712017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO I~tIGHTS 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 BE'T'WEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: ff the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ~'I,DDITIONAL 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 confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME; PAUL VOLZ INSURANCE AGENCY INC PHONE - FAX 450 SISKIYOU BLVD #5 - ac No E-MAIL ADDRESS: INSUREiR(S) AFFORDING COVERAGE NAIC # ASHLAND OR 97520 SCOTTSDI~LE INSURANCE COMPANY INSURER A INSURED ' INSURER B MATT ISON - INSURER C DBA HOOPER SPRINGS TREE SERVICE INSURER D PO BOX 3258 - INSURER E ASHLAND OR 97520 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TFI1= INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OF. OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES Cf_SCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAII, CLAIMS. INSR L POLICY EFF P(I I_ICY EXP LTR TYPEOFINSURANCE POLICY NUMBER MM D M~'L'DD1YY LIMITS X COMMERCIAL GENERALLIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ~ OCCUR PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 A X CPS2656904 05122!2017 0522/2018 pERSONAL~ADVINJURY $ 1,000,000 GEN'LAGGREGATELIMITAPPLIESPER: GENERAL AGGREGATE $ 1,000,000 X POLICY ~ PRO- ❑ JECT LOC PRODUCTS - COMPIOP AGG $ 1,000,000 OTHER: AUTOMOBILE LIABILITY ~ COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY {Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESSLIAB CLAIMS-MADE AGGREGATE DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y ~ N STATUTE ER ANYPROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBEREXCLUDED? ❑ N/A E.L. EACH ACCIDENT $ (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS ! LOCATIONS f VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more sp; ~;e is required) TREE SERVICE THE CITY OF ASHLAND, ITS OFFICERS, EMPLOYEES AND AGENTS SHALL BE NAMED AS ADDITIONAL INSURED PER CG2013 (04113) -ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISIOP~I -PERMITS OR AUTHORIZATIONS RELATING TO PREMISES CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION I~I~4TE THEREOF, NOTICE WILL BE DELIVERED IN THE CITY OF ASHLAND ACCORDANCE WITH'!'HE POLICY PROVISIONS. 20 E MAIN ST AUTHORIZED REPRESENTATIVE ASHLAND OR 97520 ©1988•!015 RD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks oi'' ACORD