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HomeMy WebLinkAboutInsurance Certificate: Pressure Point Roofing Inc. DATE (MM/DD/YYYY) ,4`oizo® CERTIFICATE OF LIABILITY INSURANCE oz/o9/zole 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 NAME Krl Hart Insurance Agency - Medford PHONE - Btl Dolmage FAX PO Box 1240 (A/C No Ext (541) 779-4232 I (FAX E-MAIL Grants Pass OR 97528 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC p INSURERA:SAIF Corporation 36196 INSURED (541) 772-1945 INSURER B: Mutual of Enumclaw Insurance Co. 14761 Pressure Point Roofing Inc. INSURER C: Cincinnati Specialty Underwrit 13037 5235 Rainbow Drive INSURERD: Central Point OR 97502 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: Cert ID 6368 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 TYPE OF INSURANCE ADDL SUBR LTR POLICY NUMBER MM DD/YYYY MMIDD/YYYY LIMITS C X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 DAMAGE TO RENTED CLAIMS-MADE IX I OCCUR Y Y CSU0068454 03/29/2018 03/29/2019 PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ❑ PRO LOC PRODUCTS-COMP/OPAGG $ 2,000,000 JECT OTHER: Empl Benefits Liab $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident 1,000,000 C X ANY AUTO y CPP0002914 12/06/2017 12/06/2018 BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY Per accident AUTOS ONLY E I $ C UMBRELLA LIAB X OCCUR CSU0068455 03/29/2018 03/29/2019 EACH OCCURRENCE $ 2,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DED RETENTION $ $ WORKERS COMPENSATION C Y/N 945959 10/01/2017 10/01/2018 X STATUTE ERH AND EMPLOYERS' LIABILITY - ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 11000,000 If yes, describe under 1,0001000 DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ l $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holders are included as Additional Insured per attached forms CSGA4031 and Waiver of Subrogation per form CSGA4087 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. 20 E Main Street AUTHORIZED /REPRESENTATIVE Ashland OR 97520 ~r" C<tGYllf ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 1