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HomeMy WebLinkAboutInsurance Certificate: Rogue Waste Systems LLC Client#:1137013 ROGUEWAS ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/0112021 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Teresa Weston USI Insurance Services NW PHONE 541 685-5300 FAX (AIC,No,Ext): I(A/C,No): 975 Oak Street,Suite 900 a ARASS: teresa.weston@usi.com Eugene,OR 97401 INSURER(S)AFFORDING COVERAGE NAIC# 541 685-5300 INSURER A:Greenwich Insurance Company 122322 INSURED INSURER B:XL Specialty Insurance Company 37885 Rogue Waste Systems LLC INSURER C:SAIF Corporation 36196 One West Main St.,Suite 401 Medford,OR 97501 INSURER D: INSURER E: 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. LTR ,TYPE OF INSURANCE INSRL SUBR WVD POLICY NUMBER /YPOLICY EFF POLICY EXP LIMITS (MM/DDYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY GEC003582710 10/01/2021 10/01/2022 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $100,000 X BI/PD Ded:1,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY JECOT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY AEC003582410 10/01/2021 10/01/2022(E0 aBcideD SINGLE LIMIT 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY _ AUTOS ONLY (Per accident) B x UMBRELLA LIAB X OCCUR UEC003582510 10/01/2021 10/01/2022 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 DED X RETENTION$$10,000 $ C WORKERS COMPENSATION 519473 10/01/2021 10/01/2022 ;MUTE EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City of Ashland,Oregon and its elected officials,officers and employees are listed as additional insureds but only with respects to the services provided by Rogue Shred,LLC. CERTIFICATE HOLDER CANCELLATION 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 St. ACCORDANCE WITH THE POLICY PROVISIONS. Ashland,OR 97502-0000 AUTHORIZED REPRESENTATIVE 044-1 IL& ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S33568645/M33467329 LBSZP This page has been left blank intentionally. • USI INSURANCE SERVICES CERTIFICATE RETURN MAIL PROCESSING • PO BOX 629035 EL DORADO HILLS CA 95762-9035 CITY OF ASHLAND 20 E MAIN ST ASHLAND OR 97520-1814