HomeMy WebLinkAboutInsurance Certificate : Ledford Construction Co. Client#: 173327 LEDFCONS2
ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY)
9/28/2021
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 any rights to the certificate holder in lieu of such endorsement(s). . ,
PRODUCER CONTACT Therese Pritchett
Propel Insurance PHONE 541 494-7744 FAX 866 577-1326
(AIC,No,Ext): (A/C,No):
Medford Workers Compensation E-MAIL therese. ritchett elinsurance.com
P O Box 936 ADDRESS: P @Pro P
Medford,OR 97501 INSURER(S)AFFORDING COVERAGE NAIC it
INSURERA:SAIF Corporation 36196
INSURED INSURER B:
Ledford Construction Company
P.O. Box 910 INSURER C:
Medford,OR 97501-0221 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 CONTRACTOR 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
RTYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP
LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
CLAIMS-MADE OCCUR PREMISES(Ea occu ence) $
MED EXP(Any one person) $
PERSONAL •&ADV INJURY $ .
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
PRO-
POLICY - JECT LOC - PRODUCTS-COMP/OP AGG $ _
OTHER: $ .
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT .
• (Ea accident) $
ANY AUTOBODILY INJURY(Per person) $
OWNED SCHEDULEDBODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $ _
AUTOS ONLY AUTOS ONLY (Per accident)
S
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTIONS $
A WORKERS COMPENSATION 811889 10/01/2021 10/01/2022 X PER X OTH-
AND EMPLOYERS'LIABILITY Y/N STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S1,000,000
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)
CERTIFICATE HOLDER CANCELLATION
City of Ashland Dept of Public SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Works ACCORDANCE WITH THE POLICY PROVISIONS.
20 E Main St
Ashland,OR 97520 AUTHORIZED REPRESENTATIVE
01988-2015 ACORD CORPORATION.All rights reserved.
ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD
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