HomeMy WebLinkAboutInsurance Certificate: JAM Construction
ACO ® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDnYYYV)
lI`~ 09/10/2019
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 of such endorsement(s).
PRODUCER CONTACT
NAME: Rristi Dolma e
Hart Insurance Agency - Medford PHONE (FM
PO Box 1240 (541) 779-4232 alC No:
E-MAIL
Grants Pasa OR 97528 ADDRESS: kdolmage@hartinsurance.com
INSURERSAFFORDINGCOVERAGE NAICa
INSURERA: SAIF Corporation 36196
INSURED INSURERS:
JAM Construction Inc
INSURER C :
682 Mountain View Drive INSURER D:
Medford OR 97504 INSURER E:
INSURER F :
COVERAGES CERTIFICATE NUMBER: Cert ID 13422 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.
INSIR TYPEOFINSURANCE ADDLSUER POLICYNUMBER MPOLICY EFF MIDDFYYYY MWDOIY VEXP
Y LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
DAMAGE O RENTED
CLAIMS-MADE ❑ OCCUR PREMISES Ea occurrence $
MED EXP (Any we person) $
PERSONAL$ADV INJURY $
GENL AGGREGATE LIMIT APPLIES PER GENERALAGGREGATE $
R POLICY ❑ JEST F-1 LOG PRODUCTS-COMPIOPAGG $
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE OMIT $
Ea acddenl _
ANYAUTO BODILY INJURY (Per person) $
OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS ONLY ALTOS
HIRED NON-OWNED PROPERTVOAMAGE $
AUTOS ONLY AUTOS ONLY Peraccidant
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAW&MADE AGGREGATE $
DED RETENTION$ $
A AND EMPLOYERS' LIABILITY YIN 974161 10/01/2019 10/01/2020 X STATUTE ERH
WO EMPLOYER
ANYPROPRIETORIPARTNERIEXECUTIVE E.L. EACH ACCIDENT $ 500,000
OFFICERIMEMBEREXCLUDED7 F-1 NIA (Mandatory In NH) E.L DISEASE-EA EMPLOYEE $ 500,000
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L DISEASE - POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is required)
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 Public Works Dept ACCORDANCE WITH THE POLICY PROVISIONS.
.
20 E. Main Street AUTHORIZED REPRESENTATIVE
Ashland OR 97520 O
01988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
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