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HomeMy WebLinkAboutInsurance Certificate: Pacific Paving ® CITY RECORDER CERTIFICATE OF LIABILITY INSURANCE 9 DAT/24/2D/YYYYj 9/24/2018 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 endorsement(s). PRODUCER CONTACT KPD Insurance, Inc. NAME: PO Box 764 PHCH o IEtl, 541-741-0550 NC Not: 541-741-1674 Springfield OR 97477 AEMIL we-cents k dlnsurance.com eas. INSURERS AFFORDING COVERAGE NAIC# INSURER A: SAIF CO Orat-ion 36196 INSURED PACIPAV01W Pacific Paving, Inc. INSURER B: PO Box 2370 INSURER C: White City OR 97503 INSURER D: NSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1290730260 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 ADO SUER LTR TYPEOFINSURANCE POUCYNUMBER MMMDNY F MMUD FXP LIMITS COMMERCIALGENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE EJOCCUR PREMISES Ise occurrence $ MED EXP(Any one person) $ PERSONAL BADV INJURY $ GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ POLICY ❑ JECT ❑ LOC PRODUCTS -COMP/OPAGG $ OTHER: S AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT H ANYAUTO Ea odd. $ BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Peraccident $ S UMBRELLALIAB OCCUR EACHOCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETENTION S $ A WORKERS COMPENSATION 812919 10/12018 1011/2019 X ANDEMPLOYERS'LU\BIUTY YIN TATUTE X ERH S ANYPROPRIETOR/PARTNER/FXECUTIVE NIA E.L. EACH ACCIDENT $1,000,000 OFFICERIMEMBEREXCLUDED? (Mandatory In NH) E.L DISEASE-EA EMPLOYEE $1.000,000 Dyy, describeunder If esmbe FOPERATIONS below E.L. DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS l VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is required) RE: All Operations CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRA77ON DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland 90 N Mountain Ave. AUTHORIZEDREPRESENTATIVE Ashland OR 97520 ©1988--2016 AA,LCCOORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD