HomeMy WebLinkAboutInsurance Certificate: Kevin Frison Tree Service (2) ACCIR DATE(MMIDDIYYY)
CERTIFICATE OF LIABILITY INSURANCE 02/14/2018
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 and endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements.
PRODUCER CONTACT
NAME: Berkley Assigned Risk Services
PHONE FAX
(NC.No.Ext.): (855)657-9792 (NC.No.): (866) 215-8118
EMAIL
ADDRESS: PolicyServices @berkleyrisk.com
INSURER(S)AFFORDING COVERAGE NAIC#
INSURED INSURER A: Riverport Insurance Co 36684
KEVIN FRISON TREE SERVICE, LLC INSURER B:
356 SILVER CREEK DR
CENTRAL POINT, OR 97502-2094 INSURER C:
INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN INSSUED 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
INSR WVD (MM/DD/YYYY) (MWDD/YYYY)
WORKERS COMPENSATION AND STATU- ❑OTHER
EMPLOYERS'LIABILITY TORY LIMITS
ANY PROPRIETOR/PARTNER/ E.L.EACH ACCIDENT $500,000
A EXECUTIVE OFFICE/MEMBER Y N/A E.L.DISEASE-EA EMPLOYEE $500,000
EXCLUDED?(Y/N) ❑ ORARP300609 04/01/2017 04/01/2018
(Mandatory In NH) E.L.DISEASE-POLICY LIMIT $500,000
If yes,describe under DESCRIPTION OF
OPERATIONS below.
❑ ❑
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required)
Election Category Election Status Name Effective Expiration All Insured Entity
Owner Excluded KEVIN FRISON 04/01/17 04/01/18 KEVIN FRISON TREE SERVICE,LLC
• Risk Location
356 SILVER CREEK DR,CENTRAL POINT OR 975022094
COMMENTS
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CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
The City of Ashland EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
51 Winburn Way POLICY PROVISIONS.
Ashland,OR 97520 AUTHORIZED REPRESENTATIVE
Signature:
ACORD 25 (2010/05) BRAC 3139
Policy Number:ORARP300609
Insured Name: KEVIN FRISON TREE SERVICE, LLC
The City of Ashland
51 Winburn Way
Ashland, OR 97520
The City of Ashland
51 Winburn Way
Ashland,OR 97520
Certificate Holder Address page