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HomeMy WebLinkAboutInsurance Certificate: ABF Business l ® DATE (MM/DD/YYYY) ACC?R° CERTIFICATE OF LIABILITY INSURANCE 2/26/2018 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 NAME: Sheryl Wlrts Protectors Insurance, LLC PH FAX P.O. Box 4669 IA/M_ t • (541)842-2968 A/c No): (541)772-1906 Medford OR 97504 ADDRESS: sherylw@protectorsins.com INSURERS AFFORDING COVERAGE NAIC # INSURER A : Travelers INSURED ABFBU-1 INSURER B : SAIF Corporation 524113 ABF Business Forms LLC DBA Apex Business Forms INSURERC: PO Box 1306 INSURER D : Medford OR 97501 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 74561032 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES Or 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 TYPE OF INSURANCE INADDL SR SUWVD ER LTR POLICY NUMBER MM/DD/YYYY MM DD/YYYY LIMITS A GENERAL LIABILITY N N 680-3E841318-18-42 3/19/2018 3/19/2019 EACH OCCURRENCE $ 1,000,000 _ DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 300,000 CLAIMS-MADE OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ PRO- $ X POLICY LOC A AUTOMOBILE LIABILITY N BA-3E842167-17 3119/2018 3/1912019 COMBINED SINGLE LIMIT Ea accident $1,000,000 X 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 H OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ B WORKERS COMPENSATION 788933 10/112017 10/1/2018 X WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L. EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE, $ 500,000 _ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS if VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) 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. City of Ashland 20 E. Main Street AUTHORIZED REPRESENTATIVE Ashland OR 97520 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD