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Home My WebLink AboutInsurance Certificate: RW Hays Co, DBA: Hays Oil Company faxmodeml (3/4) 06/27/2018 02:39:35 PM -0700 ~Rd CERTIFICATE OF LIABILITY INSURANCE DA'~(w81201 o112JV2()18 THIS CERTIFICATE IS ISSUED ASA 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(lest) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION 15 WAIVED, sub)ect to the forms 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 NAYEa Pam Wlmmer Eillott Powell Baden and Baker Inc. PHONE - (503) 227-1771 no FAX (503) 274-7644 An ISU Network Member noDRESS: Pwimmer@.pbb.com 1521 SW Salmon Street INSURER AFFORDING COVERAGE NAIC$ Portland OR 97205-1783 INSURERA- United States Fire Insurance Co. 211113 INSURED MURER Is: Certain Underwriters at Lloyds AA1122000 RW Hays 0o, DBA: Hays Oil Company mquRER c: Endurance American Specialty Ins Co 41718 PO Box 1220 INS R RE: Medford OR 97501 INSURER F: COVERAGES CERTIFICATE NUMBER: 18-19 GL, AutD, XS REVISION NUMBER: THIS IS TO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTOTHE INSURED NAMEDA13OVE FORTHE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OFANY CONTRACTOR OTHER DOCUMENTWITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPEOFINSURANCE INS POUCYNUMeEP (MMfDDfYYYY1 orris X COMMERCIAL OMERALLL461UTY - EACH OCCURRENCE $ 1.000.000 CWMSMADE 19 OCCUR PREMISES Eao=ffmwe $ 100,()00 MED EXP(Aw/one Personl $ Excluded A Y 506-8942155 07/01/2018 07/01/2D79 PERSONAL&ADV INJURY 1,000,ODO GEML AGGREGATE LIMIT APPLES PER: GENERA-AGGREGATE S 2,000,00D X POUCY ❑ jERT 0 too PRODUCTS-COMP/OPAGG S 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COM o~ SINGUE LIMIT O $ 1,000,000 Ise ANYAlJTO SODI LY INJURY (Per person) $ A OWNED SCHEDULED 506.894215-5 07/0112018 0711112019 BODILY INJURY(PW acddwa $ AUTOS ONLY AUTOS HIRED AUTOSONLY H 1 AUTOS ONLY (per AWWOM) UMBRELLA UAB OCCUR EACH OCCURRENCE EXCESS UAB CLAIMS-MADE 18'RENMA1700055-101579'01 07/01/2018 07/012019 AGGREGATE DEO RETENTION $ WORKERS COMPENSATION PER AND EMPLOYERS' LIABILITY Y/N STATUTE FR ANYPROPMEORIPARTNERIEXECUTNIE N/A EL EACH ACCIDENT OFFICER/MEMBER EXCW DED7 FS Mandatory lP NH) EL DISEASE-EA EMPLOYEE Ilyo%desabeundw DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY UMIT $ Each Occumence $4,000,000 C/A Property Li of Liability Others In Transit EXC900003825011506-894215-5 07/D7/2018 071012018 Aggregate $4,000,000 In Trensil $50,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached N mom apace to mquheQ Re: Delivery of Fuel. CG 20 26 0413 Is attached. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cityof Ashland ACCORDANCE WITH THE POLICY PROVISIONS. g0 N Mountain Ave AUTHORIZED REPRESENTATIVE Ashland OR 97520L L1 J ®1888-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD faxmodeml (4/4) 06/27/2018 02:40:23 PM -0700 POLICY NUMBER: 506-894215-5 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION THAT THE INSURED HAS AGREED BY WRITTEN CONTRACT OR WRITTEN AGREEMENT TO NAME AS AN ADDITIONAL INSURED AND EXECUTED PRIOR TO THE OCCURRENCE OF ANY LOSS. ii Information required to complete this Schedule If not shown above will be shown in the Declarations. A. Section II - Who Is An Insured Is amended to B. With respect to the Insurance afforded to these include as an additional insured the person(s) or additional Insureds, the following is added to organization(s) shown In the Schedule, but only Section III - Limits Of Insurance: with respect to liability for "bodily injury", "property If coverage provided to the additional Insured is damage" or "personal and advertising Injury" required by a contract or agreement, the most we caused, In whole or In part, by your acts or will pay on behalf of the additional Insured is the omissions or the acts or omissions of those acting amount of insurance: on your behalf: 1. In the performance of 1• Required by the contract or agreement; or p your ongoing operations; or 2. Available under the applicable Limits of 2. In connection with your premises owned by or Insurance shown in the Declarations; rented to you. whichever Is less. However: This endorsement shall not increase the 1. The Insurance afforded to such additional applicable Llmlts of Insurance shown In the Declarations. Insured only applies to the extent permitted by law; and 2. If coverage provided to the additional Insured Is required by a contract or agreement, the Insurance afforded to such additional Insured will not be broader than that which you are required by the contract or agreement to provide for such additional Insured. CG 20 26 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 1 xmodeml (1/4) 06/27/2018 02:38:58 PM -0700 This is a fax from qpb8h 1'lpstirance . lr3 i. 1521 SW Salmon St. Portland, OR 97205 503-227-1771 503-274-7644 (main fax) Date: 06/27/2018 02:38:23 PM # of pages: 3 Fax 15414885320 Email: LJohnson@epbb.com Subject: Renewal Certificate R W Hays Comments: Lori A Johnson Assistant Account Manager Energy/Environmental Department ELLIOTT, POWELL, BADEN & BAKER, INC. Phone: 503-445-8433 Fax: 503-445-8493 Ijohnson@epbb.com CA Non Resident License # 0174495 If you have had a remarkable experience Click here to leave us a review on Google!<https l/www.google.com/search?q=epbb+insurance&sourceid=ie7&rls=com.microsoft:en-US:IE-Ad ress&ie=&oe=&gws rd=ssl#gws_rd=ssl&Ird=Ox54950alc66b25e0f:Ox5b6e2c0e410ccd62,2> To make payment online click here<https://www.securevcheck.com/insurance.php?id=epbb>. To send us an encrypted secure email click here<htips:Hsecuremail.epbb.com/filedrop/-30S5Y7> This communication, including any attachments, is intended for the sole and exclusive use of the addressee and may contain proprietary, confidential, and/or privileged information. If you are not the intended recipient, any use, copying, disclosure, dissemination, or distribution of the information is strictly prohibited. If you are not the intended recipient, please notify the sender immediately and delete this communication by destroying all copies. faxmodeml (2/4) 06/27/2018 02:39:22 PM -0700 Fax To: City of Ashland Fax: 5414885320 From. Lori Johnson Phone: (503)445-8433 Email: ljohnson@epbb.com Date: 612712018 2:13 PM Subject: Renewal Certificate R W Hays Memo: Attached please find the renewal Certificate for RW Hays Co. for the policy term 2018-2019 Please do not hesitate to contact me if you need anything else. Thank you, Lori Johnson ljohnson@epbb.com