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HomeMy WebLinkAboutInsurance Certificate: American Industrial Door LLC; American Industrial Door Co. AMERIND-03 ~S_PARIANI ,4~ORU CERTIFICATE OF LIABILITY INSURANCE 0 D7/12/!2201018 ) 071128 I 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: Medford Office PHONE PayneWest Insurance, Inc. (A/c, No, Extl(541) 779-1321 (A/C, No 0411) 779-9187 - 38 North Central Ave. E-MAIL Medford, OR 97501 _.INSURERLS) AFFORDING COVERAGE NAIC # INSURER A' Western National Assurance Company 24465 INSURED INSURER Be Western National Mutual Insurance Comp7r11/ 1537] American Industrial Door LLC; American Industrial Door Co. INSURER C . 5022 Table Rock Rd. INSURER D: Central Point, OR 97502 INSURER E : _ _ INSURER F COVERAGES CERTIFICATE NUMBER: 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 ADDLSUBR POLICY EFF POLICY EXP TYPE OF INSURANCE INSD__'~VyP POLICY NUMBER LMrppryyYYl (MM/DDlYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY $ I EACH OCCURRENCE 1'1 _ _ 00,000' CLAIMS MADE X OCCUR X CPP105950206 0612312018 06/23/201 9 _.PREMI5ES°LEa aCGSrrgnce $ 5,000• __MED_EXP_jAny_one person) $ _PERSONAL & ADV-INJURY~$ 1,000,000 GEN L AGGREGATE LIMIT APPLIES PER I GENERAL AGGREGATE. $ 21000,000 POLICY X PRO- JECT 2 LOC - PRODUCTS - COMP/OP AGG '000'U0U OTHER $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 X ANY AUTO x CPP105847106 06/23/2018 06/23/2019 6oD LY wJURY Perperson $ OWNED SCHEDULED _ AUTOS ONLY AUTOS 8OD~ILY INJURY iPer accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident)- $ $ B X - UMBRELLA LIAR X OCCUR 2,000,000! EACH OCCURRENCE $ _ EXCESS LIAR CLAIMS MADE UMB100969306 06/23/2018 06/23/2019 `AGGREGATE 2,000,000t - - DED X RETENTION $ 10,000 WORKERS COMPENSATION PER OTH- ANO EMPLOYERS' LIABILITY Y / N $TATUTE _.E.R AN" PROPRIETOR)PARTNERIE)(ECLTIVE E.L. ACCIDENT $ _ _ l pFFICERIME.MBER EXCLUDED? N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes describe under DESCRIPTION OF OPERATIONS below _ E L. DISEASE - POLICY LIMIT $ i DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 'RE: 2013 Slurry Seal Project #2013-10 i 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 ACCORDANCE WITH THE POLICY PROVISIONS. 20 E. Main St. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE i I ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD