HomeMy WebLinkAbout1991-104 Ins Cert. - McCormick 1648/83 CERTIFICATE OF INSURANCE SD
This certifies that ~] STATE FARM iqRE AND CASU'A[ TY COMPANY, Bloomington, Illinois
[~ SI ATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois
insures the following policyholder for the coverages indicated below:
~4C O).RMECK, RONAfZ) J DBA f4C C~)RMIC3K AND ASSOCIATES
Name of policyholder
Address of policyholder
160 GR(JJSE CP~ZEK R) '~ ?'~i~
GRANTS PASS OR 97526-780'7
S~qE
Location of ope(ations
Description of operations
The policies tinted below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is subject to all the terms
exclusions, and conditions of those policies The limits of liability shown may have been reduced by any paid claims
POLICY PERIOD
POLICY NUMBER TYPE OF INSURANCE Effective Date i Expiration Date
Comprehensive I
This insurance includes
LIMITS OF LIABILITY
(st beginning of policy period)
BODILY INJURY AND
PROPERTY DAMAGE
Products Completed Operations
Contractual Liability
Underground Hazard Coverage
Personal Injury
Advertising Injury
Explosion Hazard Coverage
Collapse Hazard Coverage
General Aggregate Limit applies to each project
POLICY NUMBER
97-06-4072-8
[]
EXCESS LIABILITY
Umbrella
Otber
Workers' Compe~sation
and Employers Liability
POLICY PERIOD
Effective Date Expiration Date
POLICY PERIOD
Effective Date i Expiration Date
i .
Each Occurrence $
General Aggregate $
Products - Completed
Operations Aggregate $
BODILY INJURY AND PROPERTY DAMAGE
(Combined Single Limit)
Each Occurrence $ _ _
Aggregate $-- -- --
Part 1 STATUTORY
Part 2 13ODILY INJURY
Each Accident
Disease Each Employee
Disease - Policy Limit
LIMITS OF LIABILITY
(at beginning of policy period)
TYPE OF INSURANCE
BUSINESS-fk~_~I CE
500,000
TEEREAFFER UN~TIL CAkICELLtKO
Name and Address of Certificate Holder
' STEVEN M HA~L PE
PUBLIC WORKS DIRECFO.R
CI'i~¢ OF ASr{lAND
ASHLAND OR 97520
If any of the described policies are canceled before its
expiration date, State Farm will try to mail a written notice to
the certificate holder -- days before cancellation If,
however, we fail to mail such notice, no obligation or liability
will be imposed on State Farm or its agents or represents
tives.
C.E. RUCKER INS.
AGEI%Y, l,~!C.
R.K ,' '[