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Home My WebLink AboutInsurance Certificate: Evergreen Job and Safety, Incorporated CERTIFICATE OF LIABILITY INSURANCE DATE(MM/2 Y02 3/5/ 6 6 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 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 NAME: Christina Moit AssuredPartners of California Insurance Services q/CON No, Ext: (510)437-1900 q/c,No: 16 Bryson Drive E-MAIL certificates@cdginsurance.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# Sutter Creek CA 95685 INSURERA:Landmark American Ins Co 33138 INSURED INSURER B Evergreen Job and Safety, Incorporated INSURER C: 1352 Palmerston Loop INSURER D: INSURER E Roseville CA 95678-1176 INSURER F: COVERAGES CERTIFICATE NUMBER:CL263521568 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 OFANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALL 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 LIMITS LTR INSD WVD POLICY NUMBER MM/DDNYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAA CLAIMS-MADE Ex_]OCCUR PREMISES (E.occurrence)RENTED 50,000 PREMISES Ea occurrence $ X Y LHC874436 3/14/2026 3/14/2027 MED EXP(Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 JECT X POLICY ❑ PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 1,000,000 X OTHER: Professional Liability Policy Aggregate $ 2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS Per accident UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) THIS CERTIFICATE SERVES AS PROOF OF COMBINED PROFESSIONAL AND GENERAL LIABILITY COVERAGE Additional Insured per RSG 55005 0710 Waiver of Subro per RSG 54078 0310 Primary and Noncontributory per RSG 54155 0816 Notice of Cancellation per RSG 56135 0523 CERTIFICATE HOLDER CANCELLATION cobi.glick@ashland.or.us SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland — Electric Dept. THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Attn: Cobi Glick ACCORDANCE WITH THE POLICY PROVISIONS. 90 N. Mountain Ave. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE Christina Moit/CM ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) ADDITIONAL COVERAGES Ref# Description Coverage Code Form No. Edition Date Al Blanket RSG 55005 Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Included Ref# Description Coverage Code Form No. Edition Date Damage to Premises Rented to You Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 50,000 Ref# Description Coverage Code Form No. Edition Date WAIVER OF TRANSFER of Rights RSG 54078 Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Included Ref# Description Coverage Code Form No. Edition Date Professional Liability Retroactive Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 2/5/14 Ref# Description Coverage Code Form No. Edition Date Primary Non-Contributory RSG 54155 Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Included Ref# Description Coverage Code Form No. Edition Date Professional Liability Each Claim Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 1,000,000 2,500 Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium rOFADTLCV Copyright 2001,AMS Services,Inc.