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ACORO
16._~ CERTIFICATE OF LIABILITY INSURANCE 05/20/2018
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 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 CONTACT Jona Bolin
NAME:
Sammamish Insurance, Inc. PnHCNri Ext : (425) 898-8780 ac Nn (425) 836-2865
704 228th Ave NE, PMB 373 E-MAIL JonaBolin@msn.com
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
Sammamish WA 98074 INSURERA: Ohio Security Insurance Company 24082
INSURED INSURER B : The Ohio Casualty Insurance Company 24074
RH2 Engineering Inc INSURER C : Rated by Multiple Companies 00914
22722 29th Dr SE Ste 210 INSURER D : Continental Casualty Company 20443
INSURER E :
Bothell WA 98021 INSURER F :
COVERAGES CERTIFICATE NUMBER: CL1852003286 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.
INSR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
DAMAGE TO CLAIMS-MADE F _]OCCUR PREM 'SEC Ea occur ence $ 2,000,000
MED EXP (Any one person) $ 15,000
A Y BZS57962270 05/29/2018 05/29/2019 PERSONAL & ADV INJURY $ 2,000,000
MGE N LIMITAPPLIES PERGENERAL AGGREGATE $ 4,000,00POLICY ❑ PRO- 4,000,000
0
❑ LOC PRODUCTS - COMP/OP AGG $
JECT
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
Ea accident
X ANYAUTO BODILY INJURY (Per person) $
A OWNED SCHEDULED BAS57962270 05/29/2018 05/29/2019 BODILY INJURY (Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
BACEE $
X UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ 2,000,000
B EXCESS LIAR CLAIMS-MADE US057962270 05/29/2018 05/29/2019 AGGREGATE $ 2,000,000
DIED X BE I ENTION S 10,000 $
WORKERS COMPENSATION SPER OTH-
AND EMPLOYERS' LIABILITY TATUTE ER
Y I N
1,000,000
C ANY PROPRIETOR/PARTNER/EXECUTIVE N/A 52WECDL6432 10/14/2017 10/14/2018 E. L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? 1,000,0()0
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $
If yes, describe under 1,000,000
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
Per Claim $3,000,000
Professional Liability
D Claims Made AEH004312321 05/29/2018 05/29/2019 Deductible $200,000
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
The City of Ashland is named as additional insured.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS.
520 N Main St.
AUTHORIZED REPRESENTATIVE
Ashland OR 97520
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