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HomeMy WebLinkAboutInsurance Certificate: Reginald DeVore dba DeVore Electric & Construction ACS CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD,YYYY) 4k.....---- 04/12/2020 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY ANkCONFERSNo,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 ;Debbie D Reed Insurance Marketplace,Inc. PHN(Arc.N. Extl: (541)779-0177 (FAX FA c.No):(541)772-8235 1998 Sky Park Dr E-MAIL ADDRESS: debbie@insmarket.com Medford,OR 97501 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Allied Insurance Company 23787 INSURED INSURERB: Allied Insurance Group 23787 Reginald DeVore DBA: DeVore Electric&Construction INSURER C: Nationwide Insurance Company of America 792 E Dutton Rd INSURER D: SAIF Corporation [ Eagle Point,OR 97524-7975 _INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 00000000-1085853 , REVISION NUMBER: 28 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 ADDL SUBR POLICY EFF POLICY EXP wLIMITS LTRINSD vD POLICY NUMBER IMMIDDIYYYYI IMMIDDIYYYYI A X COMMERCIAL GENERAL LIABILITY Y ACP7565924983 02/17/2020 02/17/2021 EACH OCCURRENCE $ 1,000,000 DAMAGE RENTE CLAIMS-MADE X OCCUR PREM SESO(Ea occurrence) $ 100 000 MED EXP(Any one person) $ 10,000 PERSONAL 8ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: • GENERAL AGGREGATE $ 2,000,000 X POLICY mi LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: , $ B AUTOMOBILE LIABILITY Y ACP7565924983 02/17/2020 02/17/2021 cEa aBcideDn SINGLE LIMIT $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY X AUTOS HIRNONOS-OWNED , PROPERTY DAMAGE $ X AUTOSED ONLY X AVON (Per accident) $ C UMBRELLA LIAB X OCCUR ACP7565924983 02104/2020 02/04/2021 EACH OCCURRENCE $ 2,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DOD RETENTION S $ D WORKERS COMPENSATION 769387 03/01/2020 03101/2021 X STATUTE ETH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE _ E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N I 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 I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) City.of Ashland,Oregon,its officers,agents and employees with respect to claims arising out of the provision of work under this agreement-per attached endorsements cg7288 1216&CG 7246 11 15&auto AC 7005 0316 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. 20 E Main Street Ashland,OR 97520 AUTHO IZED REPRESENTATIVENT - (DDR) ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by DDR on April 12,2020 at 01:18PM