Loading...
HomeMy WebLinkAboutInsurance Certificate: Mawje Inc. / 1 ® ACoRO CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 08/03/2018 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 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 541-895-4515 541-741-9175 NAMP Ran Hoffstot PHONE FAX 541-741-9175 Hoffstot Insurance Agency Inc. ,vc No Ext:541-895-4515 ,vc No): E-MAIL DDRESS: rhoffstotl@farmersagent.com PO Box 219 A Creswell, OR 97426 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Truck Insurance Exchange 21709 INSURED INSURER B : Mawje Inc, INSURER C : DBA Ashland Towing & Texaco INSURER D: PO Box 715 INSURER E : Ashland OR 97520 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR I POLICY NUMBER MM/DD/YYYY MM/DD/YYYY COMMERCIAL GENERAL LIABILITY ✓ EACH OCCURRENCE $ 1,000,000 A DAMAGE TO RENTED CLAIMS-MADE 1-4 OCCUR PREMISES Ea occurrence $ 100,000 604672648 08/19/2017 08/19/2019 MED EXP (Anyone person) $ 5,000 i PERSONAL & ADV INJURY $ 1,000,000 i GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY 7 PRO- JECT E] LOC PRODUCTS - COMP/OP AGG [ $ 2, OOO 100 OTHER is AUTOMOBILE LIABILITY ✓ CO(EaM aBINED SINGLE LIMIT ' I ccident) $ 2 OOO 900 A ANY AUTO 'i BODILY INJURY (Per person) $ ✓ ALL OWNED SCHEDULED 604672648 08/19/2017 08/19/2019 BODILY INJURY (Per accident) $ AUTOS AUTOS ! NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS !AUTOS AUTOS _LPer accident) Gara e I Aggregate Y$ 4000.000 ✓ UMBRELLA LIAB ✓ OCCUR ✓ EACH OCCURRENCE $1,000,000 A EXCESS LIAB CLAIMS-MADE !I 604672650 AGGREGATE s 1,000,000 ' DED RETENTION $ 08/19/2017 08/19/2019: $ WORKERS COMPENSATION PER 0TH- AND EMPLOYERS' LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L. EACH ACCIDENT Is OFFICER/MEMBER EXCLUDED? N 1A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Garagekeeper/On Hook 604672648 08/19/2017 08/19/2019! $80,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 2925 Highway 66, Ashland, OR 97520 There is 30 days notice of cancellation on all policies to the certificate holder CERTIFICATE HOLDER CANCELLATION Additional Insured: The City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 East Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED PR SEN ATIVE © 88-2014 ACORD C RATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD