HomeMy WebLinkAboutInsurance Certificate: Ledford Construction Company
A,IC"R" ® DATE (MM/DD/VYYY(
I CERTIFICATE OF LIABILITY INSURANCE 08/13/2018
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 endorsements .
PRODUCER CONTACT
:
FEDERATED MUTUAL INSURANCE COMPANY NAME
HOME OFFICE: P.O. BOX 328 A/OCN NO Ext : CLIENT 888-333-4949 CONTACT CENTER
A/c No : 507-446-4664
OWATONNA, MN 55060 E-MAIL
ADDRESS: CLIENTCONTACTCENTER FEDINS.COM
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A: FEDERATED MUTUAL INSURANCE COMPANY 13935
INSURED 149-469-9 INSURER B:
LEDFORD CONSTRUCTION COMPANY INSURER C:
PO BOX 910
MEDFORD, OR 97501-0221 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 39 REVISION NUMBER: 1
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 DDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS
LTR TYPE OF INSURANCE INSR WVD MMIDDIYYYY MM/DD/YYYY
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000
DAM AGE To RENTD
CLAIMS-MADE FxIOCCUR PREMISES Ea oc uE rrence $100'000
MED EXP (Any one person) EXCLUDED
A Y N 9912146 04/20/2018 04/20/2019 PERSONAL & ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
POLICY ❑ PRO- ❑ LOC PRODUCTS - COMP/OP AGG $2,000,000
X PRO
JECT OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000
Ea accident
X ANY AUTO BODILY INJURY (Per person)
OWNED AUTOS ONLY SCHEDULED
A AUTOS Y N 9912146 04/20/2018 04/20/2019 BODILY INJURY (Per accident)
NON-OWNED PROPERTY DAMAGE
HIRED AUTOS ONLY AUTOS ONLY Per accident
X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $5,000,000
A EXCESS LIAB CLAIMS-MADE N N 9912147 04/20/2018 04/20/2019 AGGREGATE $5,000,000
DIED RETENTION
TH-
WORKERS COMPENSATION PER STATUTE DER
ER
AND EMPLOYERS' LIABILITY Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? N I A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE
.
If yes, describe under E.L DISEASE -POLICY LIMIT
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
SEE ATTACHED PAGE
CERTIFICATE HOLDER CANCELLATION
149-469-9 39 1
CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
DEPT OF PUBLIC WORKS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
20 E MAIN ST ACCORDANCE WITH THE POLICY PROVISIONS.
ASHLAND, OR 97520-1814
AUTHORIZED REPRESENTATIVE
O 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: 149-469-9
LOC
ACORO~
ADDITIONAL REMARKS SCHEDULE Page of
AGENCY NAMEDINSURED
FEDERATED MUTUAL INSURANCE COMPANY LEDFORD CONSTRUCTION COMPANY
PO
POLICY NUMBER BOX 910
SEE CERTIFICATE # 39.1 MEDFORD, OR 97501-0221
CARRIER NAIC CODE
SEE CERTIFICATE # 39.1 EFFECTIVE DATE: SEE CERTIFICATE # 39.1
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE
THE CITY OF ASHLAND, OR, AND IT'S ELECTED OFFICIALS, OFFICERS AND EMPLOYEES AS ADDITIONAL INSUREDS ON GENERAL
LIABILITY AND AUTO LIABILITY BUT ONLY WITH RESPECTS TO THE CONSULTANTS PROVIDED WITHIN RESPECT TO THE CONTRACT.
INSURANCE PROVIDED BY THE GENERAL LIABILITY COVERAGE IS PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE.
INSURANCE PROVIDED BY THE BUSINESS AUTO LIABILITY IS PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE.
I
ACORD 101 (2008101) O 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD