Loading...
HomeMy WebLinkAboutInsurance Certificate: RW Hayes Co 6/26/2023 3 : 36 PM FROM: SYSTEM. TO: +15414885320 P. 2 -I S • Aco?o® CERTIFICATE OF LIABILITY INSURANCE DATE(M6/DD/YYYY) `� 06/26/2023 THIS CERTIFICATE IS ISSUED ASA 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,ANthHE 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 Kim Wykes NAME: •Elliott Powell Baden and Baker Inc. • ` PHONE (503)445;8441 , FA%,No): (503)445-8481M p�C.No.Ext): (A/C An ISU Network Member ADDRESS: kwykes@epbb.corn 1521.SW Salmon Street INSURER(S)AFFORDING COVERAGE NAIC II Portland OR 97205-1783 INSURER A: Crum&Forster Indemnity Company INSURED /INSURER B: Certain Underwriters at Lloyds / 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: 23-24 GUAuto/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 , TYPE OF INSURANCE IND M • POLICY NUMBER . POLICY EFF POLICY EXYY . LIMITS (MM/DDfYYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY • EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100,000 ' • CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ excluded A Y 5069071071 , 07/01/2023 07/01/2024 PERSONALSAOVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES n PER: I GENERALAGGREGATE $ 2,000,000 X POLICY 5N-, n LOCPRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) • ANY AUTO BODILY INJURY(Per person) $ A X OWNED SCHEDULED 5069071071' 07/01/2023 07/01/2024 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS i�- — X HIRED X NON-OED PROPERT/DAMAGE a AUTOS ONLY AUTOSWNONLY (Per accident) — ' X CA 9948 X MCS-90 $ UMBRELLA LIAB OCCUR • - EACH OCCURRENCE $ 5,000,000, B X EXCESS LIAB CLAIMS-MADE 23UKPCB230002530122506 07/01/2023 07101/2024/ AGGREGATE $ 5,000,000 DED , RETENTION$ $ WORKERS COMPENSATION PER 0TH- - AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT _ 5' (Mandatory In NH). E.L.DISEASE-EA EMPLOYEE $ If yes,describe under ,, DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Motor Truck Cargo $70,000 Limit $1,000 Chid C Excess Liability . . 5069071071/EXC30000382508 07/01/2023 07/01/2024 • $5,000,000 Limit ' • DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached II more space Is required) ' Re:Delivery of Fuel. CG 20 26 12 19 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 • S ` AUTHORIZED REPRESENTATIVE Ashland OR 97520 61<tojibt E40 1 . ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 6/26/2023 3 : 36 PM FROM: SYSTEM • TO +15414885320 P. 3 • • • • • POLICY NUMBER: 5069071071 COMMERCIAL GENERAL LIABILITY . CG 20 26 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. • ADDITIONAL INSURED. - DESIGNATED PERSON OR ORGANIZATION • This endorsement modifies insurance provided under the following: • COMMERCIAL GENERAL LIABILITY COVERAGE PART • SCHEDULE Name Of Additional Insured Person(s)Or Organization(s): • ANY PERSON OR ORGANIZATION THAT THE INSURED HAS AGREED BY WRITTEN CONTRACT OR WRITTEN AGREEMENT TO NAME AS AN ADDITIONAL INSURED AND EXECUTED PRIOR TO THE OCCURRENCE OF ANY LOSS. • • • • • Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these . • include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III —Limits Of Insurance: with respect to liability for "bodily injury", "property If coverage provided to, the additional insured is damage or "personal and advertising injuryrequired by a contract or agreement, the most we. caused, in whole or in part, by your acts or • will pay on behalf of the additional insured is the omissions or the acts or omissions of those acting amount of insurance: on your behalf: • 1. Required by the contract or agreement; or 1. Ion the performance of your ongoing operations, 2. Available under the applicable limits of 2. In connection with your premises owned by or insurance; • rented to you. • whichever is less. However: ' • This endorsement ' shall not increase the 1. The insurance afforded to such additional applicable limits of insurance. • insured only applies to the extent permitted by . law; and 2. If coverage provided to the additional insured is • required by, a contract or agreement, the • insurance afforded to such additional insured ' will not be broader than that which you are ' required by the contract or agreement to provide for such additional insured. • • • • CG 20 26 12 19 ©Insurance Services Office, Inc., 2018 • Page 1 of 1 6/2023 3 :36 PM FROM: SYSTEM , TO: +15414885320 P. 1 Delivered by Faxlt2me ax Transmission • Attention to:- From:- Name:5414885320 Name:Kim Wykes Company: Company:Elliott,Powell, Baden,&Baker- Main Fax: 5414885320 Fax: Date:06-26-2023 Telephone: Time:03:35:20 P Pages:4 RE: RW Hays,dba: Hays Oil Co Com ments/Notes: Kim Wykes Commercial Account Manager Elliott, Powell,Baden&Baker,Inc. 503-445-8441 503-445-8481 (fax) 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. • ••