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Home My WebLink AboutInsurance Certificate: American Industrial Door AMERIND-03 PHITE ACORC) DATE (MMfDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 0612012017 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 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 confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME; _ - - _ Medford Office Pa newest Insurance, Inc. I_(~r°,NN , Ext) (541) 779 1321_ _ _I_ IA c, No): (541) 779-9187 38 North Central Ave. ir_A~DRI Ess _ _ _ - - _ - - , _ Medford, OR 97501 _ _ INSURERS) AFFORDING COVERAGE - _ NAIC # - - _ 1 ENSURER A :Western National. Assurance Company _ _ 24465 INSURED ~I INSURER B : _ - ~ _ _ _ - American Industrial Door LLC; American Industrial Door Co. ~ INSURER c : _ _ ' 5022 Table Rock Rd. INSURER D ; Central Point, OR 97502 ~ - _ , _ INSURER E : _ - _ , - _ INSURER F ; CO'Vr=RAGES CERTIFICATE NUMBER: REVISION NUM~3ER: 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. LTR - - _ - _ IN _D' WUD - _ _ - 1 MMfDDIYYYY_ MM/DDIYYYY - - - - _ - - INSR TYPE OF INSURANCE ADDLISUBRJ POLICY NUMBER POLICY EFF POLICY EXP LIMITS 1,000,000 LIABILITY EACH OCCURRENCE ~ $ A X I COMMERCIAL GENERAL I I I DAMAGE TO RENTED 100~QOO CPP1059502-05 0612312017 0612312018 - I _ _ i CLAIMS-MADE I X ,OCCUR X ~ PREMIS,ES_jEa occurrence~__ ~ ~ MED EXP An~oneQerson) - ~ _ 5'000 _ ~ - ` ! 1,000,000 I ~ PERSONAL_& ADV INJURY _ } $ - _ r_ ~ ! 2,000,000 ~GENERALAGGREGATE GEN'LAGGREGATE LIMIT APPLIES PER: ' ~ I'~ 'r ~ $ --:I _ - - i ~ ~ 2,000,000 ~ PRODUCTS COMPIOP AGG , $ POLICY X jECT LOC i ~ _1 f OTHER: ~ $ A I COMBINED SINGLE LIMIT 1 OOO OOO AUTOMOBILE LIABILITY ~Ea accident) ; $ _ _ _ ~ ~ ~CPP1058471-05 06123(2017 0612312018 ~ BODILY INJURY Per erson X ANY AUTO X ; I'~, _ P _ t - _ OWNED ~ ~ --1 SCHEDULED ' i ~I---------- - - ~IAUTOS ONLY ~ - ~~i ~ BODILY INJURY~Per accident) ! $ - PROPERTY DAMAGE AU OS 0 NON-OWNED ~ (Per acoldent) $ _ ' T NLY AUTOS ONLY I i I, ~ $ i ~I A ~'i X ~ UMBRELLA LIAB X ~ OCCUR i ~ EACH OCCURRENCE 2,000,000 _ 0612312018 r 2,000,000 EXCESS LIAR CLAIMS-MADE'. UMB1009693-05 10612312017 II AGGREGATE $ I I ~ : ~ ~i X ~ 10,000, I, ; - DED RETENTION $ $ ~ _ PER ' ~ OTH- _ _ AND EMPLOYERS' L ABI ~ Y I, I STATUTE 1___i_ER__- Y I _N_ ' ~ I ~ E.L EACH ACCIDENT $ ANY PROPRIETORIPARTNERIEXECUTIVE ~ ~ ~ OFFICER/MEMBER EXCLUDED. ~ N f A I !„41z^d:,t~ry i~ "."E;) E.L DISEASE cA EMPuOYEE $ - _ - - - - _ _ ~ If yes, describe under II, DESCRIPTION OF OPERATIONS below ~ ~ E.L. DISEASE -POLICY LIMIT $ it II ' ~I II I I~ I~ ~i 'i I DESCRIPTION OF OPERATIONS 1 LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) RE: 2013 Slurry Seal Project #2013-10 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland ACCORDANCE W TH TDHE POLICY PROVISIONSCE WILL BE DELIVERED IN 20 E. Main St. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE ~y~ ACORD 25 (2016103) ©1988.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ~ DATE (MMIDDIYYYY) AC'C71RD CERTIFICATE OF LIABILITY INSURANCE 6!22/2017 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 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 confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Liberty Mutual Insurance NAMEACT PO Box 188065 Ar°N o Ext : 800-962-7132 a~c No : 800-845-3666 Fairfield, OH 45018 EMAIL aoDRESS: BusinessService@Libert Mutual.com INSURERS AFFORDING COVERAGE NAIC # INSURERA: West American Insurance CDm an 44393 INSURED INSURER B Southern Oregon Repertory Singers PO BOX 1091 INSURER C Ashland OR 97520 INSURER D : INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 36279077 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE L)STED gFL p~~/ NAVE BEEN !SSI!FD TO THE INSURED NP.I!4ED ABOVE FOR THE PJLICY 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 TYPE OF INSURANCE ADDL SUBR pOLICY NUMBER MMIDDIYYYY MM/DDIYYYY LIMITS LTR A COMMERCIAL GENERAL LIABILITY ~ BKW57800816 6/1/2017 6/1/2018 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR PREM SES~ a occur ence $ 1,000,000 MED EXP (Any one person) $ 15,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 ✓ POLICY ~ PRO ~ LOC PRODUCTS - COMPlOP AGG $ 2,000,000 JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- ANDEMPLOYERS' LIABILITY STATUTE ER ANYPROPRIETORlPARTNERlEXECUTIVE Y J N E.L. EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? N I A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under ~ DcSCRiPTiON Gi• OrPE'r'vwTiOi~S beiow c.L. GiSE;iSE - PvLiC'i ~iivt~ i $ DESCRIPTION OF OPERATIONS !LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Ashland, it's officers and employees are Additional Insured if required by written contract or written agreement subject to General Liability Blanket Additional Insured Provision. CERTIFICATE HOLDER CANCELLATION Clt Of Ashland, It's officers and em to ees SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y p Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 E Main St. ACCORDANCE WITH THE POLICY PROVISIONS. Ashland OR 97520 AUTHORIZED REPRESENTATIVE ~ Kimberleigh Howard ©1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 36279077 17000037978 117-18 Master Certificate I Kimberleigh Howard 16/22/2017 10:53:39 AM (CDT) I Page 1 of 1