HomeMy WebLinkAboutInsurance Certificate: Ground Control Southern Oregon, LLCACOR a 72/28/
(Mikil VYY)
CERTIFICATE OF LIABILITY INSURANCE zozs
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(les) 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
k.p.d. Insurance LLC PHONE Tracy Soukup--
1111 Gateway Loop A/c No):
Springfield OR 97477 ILADDRESS: Tracy. Soukup@imacorp.com
INSURER(S) AFFORDING COVERAGE NAIC N
INSURER A: Alaska National Insurance Company 38733
INSURED GROUCON01C INSURERB: SAIF Corporation __- - 36196
Ground Control Southern Oregon, LLC
6351 Blackwell Road INSURERC:
Central Point OR 97502-7317 INSURERD:
INSURER E:
INSURER F :
COVERAGES CERTIFICATE NUMBER: 1gss597nRn RFVISION NUMRFR-
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' iAUDL SUBR _ _ __ POLICY EFF POLICCY EXP - ----- - - -- -- - ___ -___.
LTR TYPEOFINSURANCE N WV I POLICYNUMBER MPWDD/YYY MMlD0/YYYY LIMITS
A
X ,COMMERCIAL GENERAL LIABILITY
I 25BPS12024 2128/2025 2/28/2026 EACH OCCURRENCE
$1.000,000
CLAIMS•MADE li. X OCCUR
�-
AMAGE TO RENTED
PREMISES {Ea ocarrencel
$1,000,000
-- --
$ 5,000
~MED EXP (Any one person)
$1.000,000
PERSONAL 8 ADV INJURY
r-
$ 2,000,0_00_
GEN'L AGGREGATE LIMIT APPLIES PER
-.,
GENERAL AGGREGATE
POLICY X JECOT LOC
_
PRODUCTS-COMP/OPAGG
$2,000,000
$ _.�.
OTHER:
A
LIABILITY
AUTOMOBILEANY
258AS12024 2/28/2025 2/28/2026 COMBINED SINGLE LIMIT
$1,000.000
_
$ — y
X AUTO
I
�
� BODILY INJURY jPerperson)
OWNED !:SCHEDULED
AUTOS ONLY AUTOS
X HIRED X NON OWNED
AUTOS ONLY �_ AUTOS ONLY
BODILY INJURY (Per accident)
PROPERTY DAMAGE
Per ent1accid
t _ . - --- -- -
$
$
$
A
XUMBRELLA LIAB IX
25BLU12024 2/28/2025 2/28/2026 EACH OCCURRENCE
$2,000,000OCCUR
EXCESS LIAB CLAIMS -MADE
_
AGGREGATE
$2,000,000
$
X
DED RETENTION $in nnn
_
B
jOFFICER/MEMBEREXCLUDE09
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANYPROP I ETORJ PARTNER/EXECUTIVE r
(MandatoryIn N l
It yes, describe under
DESCRIPTION OF OPERATIONS below
N/A'
I
100016013 j 9112024 9/1/2025 X i STATUTE ! ER
! E.L.EACH ACCIDENT
I
E L. DISEASE EA EMPLOYEE
i---
E.L. DISEASE - POLICY LIMIT
--
$ 500 000
$ 500,000
- "
$ 500,000
A Leased and Rented Equipment
A 'Cargo
i
25SIA12024 2128/2025 :. 2/28/2026 Limit $25,000
25BA12024 2/28/2025 2/28/2026 Limit $250.000
Actual Cash Value
i
Deductible $1,000
Deductible $1.000
DESCRIPTION OF OPERATIONS / LOCATIONS, VEHICLES (ACORD 101, Additional Remartcs Schedule, may be attached If more space is required)
RE: All Operations.
City of Ashland
20 E Main Street
Ashland OR 97520-1814
tLLA
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
01988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
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