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HomeMy WebLinkAboutInsurance Certificate: Pilot Rock Excavation Inc. ,acoRo® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 07/08./2021 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: Hart Insurance Agency PHONE Michelle Ely FAX PO Box 1240 - (AIC.No.Ex9: (541) 779-4232 (ac.No):(541) 772-3963 E-MAIL Grants Pass OR 97528 ADDRESS: mely@hartinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:American Hallmark Insurance Co 43494 INSURED (541) 779-4916 INSURER B: Pilot Rock Excavation Inc INSURER C: I 356 Bateman INSURER D: Medford OR 97502 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:Cert ID 19841 REVISION NUMBER: ' THIS IS TO CER11FY 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. INSIV ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDDJYYYY) (MMJDD/YYYY) LIMITS A X I COMMERCIAL GENERAL LIABILITY - EACH OCCURRENCE $ 1,000,000 DAMAGE TO RE TED CLAIMS-MADE X OCCUR Y 44CL494969 07/20/202107/20/2022 PREMISES(Ea'occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POUCY X MI: LOC PRODUCTS-COMP/OPAGG $ 2,000,000 • OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) A X ANY AUTO 44'CLI94969 07/20/2021.07/20/2022 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) • $ A X UMBRELLALIAB X OCCUR 44CL494969 07/20/2021 07/20/2022 EACH OCCURRENCE $ 5,000,000 EXCESSLIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH AND EMPLOYERS'LIABILITY Yf N - STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE N I A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory inNH) E.L.DISEASE-EA EMPLOYEE $ -- If-yes.describe under _ - _ - - - - _ __ - - - - - _ - - _ DESCRIPTION OF OPERATIONS below '� E.L.DISEASE-POLICY LIMIT $ I $ DESCRIPTION OF OPERATIONS f LOCATIONSI VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If mom space fa required) "City of Ashland and its employees, officers and agents are included as additional insured as respects to general liability and auto liability. • CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland 20 E. Main Street - AUTHORIZED REPRESENTATIVE . Ashland OR 97520 -- I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD �,•