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HomeMy WebLinkAboutInsurance Certificate: Pacific Benefit Consultants (2) DATE (MM/DD/Y.YYY) , ACS" CERTIFICATE OF LIABILITY INSURANCE- ' - 3/26/2018 .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-term's'and conditions of the policy,. certain policies may require an endorsement. A statement on this certificate does not_confer- rights'tQ e- certificate holder in lieu of such endorsement(s): - PRODUCER NAME: CT Tammy 5yrek ;r;:; t,.., r- IAPHO Pacifi8 -Bene£it LCbnsi ltants i . No. /CNE Ext : (541)484-6624 ` a No : (541) 666-2726 450 Couat~ Club :Roads:#330 i - E-MAIL •tsyrek@pbcins fcom:. rY ADDRESS: INSURERS AFFORDING COVERAGE' NAIC # Eugene - OR 97401 INSURERA:Sentinel Insurance `.Company:,, 11000 INSURED - INSURER B.-Mutual' of Enumclaw Insurance*, 14761` - - Mortier Engineering, Pe, Pc INSURERC:SAIF Co 144 E 14th Ave INSURERD:Maxum Specialty Insurance INSURER E : Eugene OR 97401 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1832625326 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. ILTR R TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DDY/YYEFF YY MMLDDY/YYYY LIMITS LT X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 [TA-MAGE TO A CLAIMS-MADE 7X OCCUR PREMISES (Ea occurrence) $ 1,000,000 X WA Stop Gap 52SBANN7141 5/7/2018 5/7/2019 MED EXP (Any one person) $ 10 , 000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY PRO ❑ LOC PRODUCTS - COMP/OP AGG $ 4,000,000 JECT OTHER: Employment Practices Liab Ins $ -10 , 000 "AUTOMOBILE LIABILITY - - - 2 COMBINED SINGLE LIMIT $ -,T 000, 000 Ea accident B ANY AUTO - - BODILY INJURY'(Per person) $ ALL OWNED;-, R , SCHEDULED BAP0004480 5%7/2017 5/7/2018 BODILY INJURY (Per accident) $ AUTOS AUTOS ' ' NON-OWNED PROPERTY DAMAGE, X HIRED"AUTOS X AUTOS' Per accident V, $ Uninsured motorist combined $ 1,000,000,x 'UMBRELLALIAB OCCUR EACH OCCURRENCE $ 4,000,000' A' "EXCESS LIAB CLAIMS-MADE AGGREGATE $ 4,-0`60"400 DED X RETENTION$ 10 0,000 52SBANN7141 5/7/2018 5/7/2019 $ PE- WORKERS COMPENSATION X AND EMPLOYERS' LIABILITY Y / N STATUTE TOROTH ANY PROPRIETOR/PARTNER/EXECUTIVE, E.L. EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? ❑ N/A C (Mandatory in NH) 951252 4/1/2018 4%1/2019 E.L. DISEASE - EA EMPLOYE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 Dv Proiessional Liability IFP602559104 12/3/2017 12/3/2018 $1,000,000 Retention $2,000,000 $10,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) I~ 9 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Community Development Department ACCORDANCE WITH THE POLICY PROVISIONS. 51 Winburn Way Ashland, OR 97520 AUTHORIZED REPRESENTATIVE Tammy Syrek/ERH ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401)