HomeMy WebLinkAboutInsurance Certificate: RW Hays Co. faxmodeml ( 3/3 ) 06/24/2019 08 : 24 : 39 AM ittE5oivrje CERTIFICATE OF LIABILITY INSURANCE I DATE(MMIDD/YYYY)
06/21/2019
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 01 such endorsement(s).
PRODUCER CONTACT Pam Wimmer
NAME:
Elliott Powell Baden and Baker Inc. PHONE (503)227-1771 I FAX ( )503 274-7644
(A/C,No,Ext): (A/C,No):
An ISU Network Member E-MAIL pwimmer@epbb.com
wimmer bb.com
ADDRESS:
1 521 SW Salmon Street INSURER(S)AFFORDING COVERAGE NAIC A
Portland OR 97205-1783 INSURER A: United States Fire Insurance Co. 211113
INSURED INSURER B: Certain Underwriters at Lloyds AA1122000
RW Hays Co. INSURER C: Endurance American Specialty Ins Co 41718
DBA:Hays Oil Company INSURER D:
PO Box 1220 INSURER E:
Medford OR 97501 INSURER F:
COVERAGES CERTIFICATE NUMBER: 19-20 GLJAUTO/MTC/XS 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 AUUL`9UB1- POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED
CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ 100,000
MED EXP(Any one person) $ Excluded
A Y 5068967211 07/01/2019 07/01/2020 PERSONAL&ADV INJURY $ 1,000,000
GENLAGGREGATE LIMIT APPLIES PER: 2,000,000
GENERALAGGREGATE $
POLICY PRO PRODUCTS-COMP/OP $
7
JECT n LOC 2,000,000
OTHER: Employee Benefits $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
(Ea eccidont)
X ANY AUTO BODILY INJURY(Per person) $
A OWNED SCHEDULED 5068967211 07/01/2019 07/01/2020 BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
X AUTOS RED ONLY _ AUTS OWNE ONLY (Per accident)
Uninsured motorist $ 1,000,000
UMBRELLA LIAB �V'"V""1RR NCE'"s 5,000,000
X OCCUR EACH OCCURRENCE $ _
B X EXCESSUAB CLAIMS-MADE 18RENMA180005510157901 07/01/2019 07/01/2020 AGGREGATE $ 5,000,000
DED I RETENTION$ $
WORKERS COMPENSATION I SATUTE I I TH-
AND AND EMPLOYERS'LIABILITY Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE I I N/A E.L EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $
II yes,describe under
DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $
Excess Liability $5,000,000 Occurrence $5,000,000 Agg
C/A Property of Others in Transit EXC30000382501/5068967211 07/01/2019 07/01/2020
In Transit $50,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more apace Is required)
Re:Delivery of Fuel. CG 20 26 04 13 Is attached.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS.
90 N Mountain Ave
AUTHORIZED REPRESENTATIVE
Ashland OR 97520 tx14M C 00
I J
®1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
faxmodeml (2/3 ) 06/24/2019 08 : 24 : 25 AM -0700
Fax
To: City of Ashland
Fax: 5414885320
From: Kim Wykes
Phone: (503) 445-8441
Email: kwykes @epbb.com
Date: 6/24/2019 8:23 AM
Subject: 2019-2020 RW Hays
Memo:
Good Morning,
A renewal certificate was issued to you on June21, 2019. An error in
our system caused the certifiate to be sent unsigned. We are
resending just the certificate. All Forms that were previously sent
are to be attached to this certificate.
Should you have any questins, please do not hesitate to contact our
office.
Sorry for the inconvenience.
Thank you,
xmodem1 ( 1/3) 06/24/2019 08 :24: 03 AM -0700
I
This is a fax from
c ustb
insurance
Elliott, Poatll,Baden&Halter,.Int\
1521 SW Salmon St. Portland, OR 97205 503-227-1771 503-274-7644(main fax)
Date: 06/24/2019 08:23:21 AM # of pages: 2 '
Fax#: 15414885320 Email: kwykes @epbb.com
Subject: 2019-2020 RW Hays
J
Comments:
Kim Wykes
Commercial Lines Account Manager
ELLIOTT, POWELL, BADEN & BAKER, INC.
P:503-445-8441 I F:503-445-8481 I kwykes@ epbb.com<mailto:kwykes @epbb.com>
Online payments<http://epbb.com/index.php/2012-08-29-22-44-42/make-a-paymenb I Secure file
system<htips://securemail.epbb,com/filedrop/kwykes @epbb.com> I Google
reviews<https://search.google.com/local/writereview7placeid=ChIJD16yZhwKIVQRYsOMQQ4sbls>
Customer feedback<Mtp://epbb.com/index.php/contact-us2/tell-us-how-we-re-doing/view/form>
[epbb logo]<http://www.epbb.com/>
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.
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