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Home My WebLink AboutEvergreen Job & Safety Training ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE 11-16-2005 PRODUCER THIS CERTIFICATE IS ISSUED AS A MJ'TTER OF INFORMATION THE HAYS GRP INC/MEDIC 1ST AID/PHS ONLY AND CONFERS NO RIGHTS uPor~ THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NO.r AMEND. EXTEND OR 620361 P: (866)467-8730 F: (877)538-8295 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO BOX 29611 INSURERS AFFORDING COVERAGE CHARLOTTE NC 28229 INSURED INSURER A: Hart ford Casualty Ins Co I INSURER B: EVERGREEN JOB & SAFETY TRAINING INSURER C: . 309 KNOCH AVE. INSURER D: SUSANVILLE CA 96130 INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER ~\'frJ~~~g~~~ "8k~Y'~M'7~Jv~~ LIMITS LTR GENERAL LIABILITY I EACH OCCURRENCE $1,000,000 A ~~MERCIAL GENERAL LIABILITY 42 SBM BW4053 01/25/06 o 1 / 2 5 / 0 7 I FIRE DAMAGE (I~ny one fire! $300,000 CLAIMS MADE lliJ DCCUR I MED EXP (Any me person) $10,000 X: Business Liab I PERSONAL & ADV INJURY $1,000,000 I I GENERAL AGGREGATE $2 , 00 0 , 0 0 0 ~'L AGGREGATE LIMIT APPLIES PER: I PRODUCTS - COMPIOP AGG $2 , 000 , 000 ! POLICY I -I ~~8T i X 1 LOC ~TOMOBlLE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea eccident) f-- f-- ALL OWNED AUTOS BODILY INJURY $ _ SCHEDULED AUTOS (Per person! : HIRED AUTOS BODILY INJURY --1 (Per accident! $ ~ NON-OWNED AUTOS I-- PROPERTY DAMAGE $ (Per eccidentl GAIIAGE LIABILITY I AUTO ONLY - EA ACCIDENT $ I-- EA ACC 1 $ _ ANY AUTO OTHER THAN AUTO ONLY: AGG $ ~ESS LIABILITY _ I EACH OCCURRENCE $ ~ OCCUR U CLAIMS MADE I AGGREGATE $ I $ 1--. I ---i DEDUCTIBLE $ i RETENTION $ $ WORKERS COMPENSATION AND 1.r,;~JT~~!;, I IOJ~- EMPLOYERS' LIABILITY E.L. EACH ACCII)ENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Those usual to the Insuredls Operations. CITY RECORDER~'S COF'/ CERTIFICATE HOLDER I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE I EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE (10 DAYS FOR NON. PAYMENT) TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OB REPRESENTATIVES. City of Ashland - Electric Dept. Attn: Scott Johnson 90 N. Mountain Ave. Ashland, OR 97520 A~~_ ACORD 25.S (7/97) e> ACORD CORPORATION 1988 I ACORDTM I PRODUCER ITHE HAYS GRP INC/MEDIC 1620361 P: (866)467-8730 PO BOX 29611 iCHARLOTTE NC 28229 INSURED I DATE 111-16-2005 I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION L]NL Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALlER THE COVE~AGE AFFORDED BY THE POLICIES BELOW. I INSURERS AFFORDING COVERAGE ~~;HartiOrd Casualty Ins CO INSURER B: CERTIFICATE OF LIABILITY INSURANCE 1ST AID/PHS F: (877)538-8295 EVERGREEN JOB & SAFETY TRAINING 309 KNOCH AVE. SUSANVILLE CA 96130 COVERAGES r1HE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD II~DICAIED. 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSURER C: INSUREF< D: ~SURER E: INSR I LTR , tEENERAL LIABILITY I A COMMERCIAL GENERAL L, lABILITY i CLAIMS MADE ~ OCCUR [] Business Liab GEN'L AGGREGATE LIMIT APPLIES PER: --I POLICY II j~gT I X -I LOC TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE I POLICY EXPIRATION DATE (MMtDD/YYI I DATE (MM/DDIYYI I 01/25/06101/25/07 I I I LIMITS EACH OCCURFlENCE I $1, 000, 000 FIRE DAMAGE (Anyone fire) I $300 , 000 MED EXP (Anyone person) ~ 1 0 , 0 0 0 PERSONAL & A~ INJURY I $1 , 0 0 0 , 0 0 0 I GENERAL AGGREGATE $2 , 000 , 000 PRODUCTS. COMP/OP AGG I $2 , 00.0, 000 I 42 SBM BW4053 AUTOMOBILE LIABILITY - _ ANY AUTO ALL OWNED AUTOS - SCHEDULED AUTOS COMBINED SINGLE LIMIT (Ea accident) NON-OWNED AUTOS I BODILY INJURY ~er person) I BODILY INJURY (Per aCCident) I I' PROPERTY DA VlAGE (Per aCCident) i AUTO ONLY - lOA ACCIDENT $ I OTHER THAN EA ACC $ _I AUTO ONLY: AGG $ I EACH OCCURFlENCE I $ ! AGGREGATE $ I I $ I I $ , I $ - HIRED AUTOS f--- ~ f--- ---.l f ~.., u,",un ~ ANY AUTO I EXCESS LIABILITY :=J OCCUR U CLAIMS MADE Rf-- DEDUCTIBLE RETENTION I I $ WORKERS COMPENSATION AND I EMPLOYERS' LIABILITY I I i Jom~ i I I ! DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS I I L I WC STATU. I ,OTH- TORY L1Mill.l. I ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ I I E.L. DISEASE - POLICY LIMIT $ ~ Those usual to the Insured's Operations. "."r-7 ....., (. ^-,- -" '--, CERTIFICATE HOLDER I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE I EXPIRATION DATE THEREOF. THE ISSUING iNSURER WILL ENDEAVOR TO MAIL 30 ~~RITTEN NOTICE (10 DAYS FOR NON-PAYMENT) TO THE CERTIFICATE' L iI'-IMED TO THE LEFT. BUT FAILURE TO DO SO SHALL IMPOSE NO Ti N OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENT A TlVES. i II City of Ashland Public Works Attn: Dan Nicholson L ORDER'S 190 N. Mountain Ave C\1Y Fl.:::C IAshland, OR 97520 I L- ACORD 25-S (7/97) A~~~_ <0 ACORD CORPORATION 1988 02/09/2006 18:23 FAX 2022634001 HAYS OF DC ~ 0011001 ACJlflf)~ CERTIFICATE OF LIABILITY INSURANCE E~~~l9 DAT~~Mt;~) THIS CERTIFICATE IS ISSUED AS A MATTER elF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AME:ND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PRODUCER Hays Affinity Solutions 1250 24th St NW Suite 725 Washington DC 20037 Phone:202-263-4000 Fax:202-263-4001 INSURED .-----...--.. .....-..- Evergreen Job' Safety Trng. Douglas Lindstrom 309 Knoch Avenue Susanville CA 96130 I I INSURERS AFFORDING COVERAGE NAIC # r7~S~RE~~~ Ll.<<?~~_.of Londo~'-----'---"-""''''''''-''-'''l..._... ~~~SURER B: _.__________..__......... ~URE~E..:...,,-......-.-....- ___.__.__...... ! INSURER 0: ___.___ I INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT. 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I~~R NSR~ TYPE OF IN;~-;;:NCE ~I!NI!RAL LIABILITY 1..~1~E~MERCIAL GENER~IAeILITY I LJ CLAIMS MADE l X : OCCUR Ii .- L---i I I !---.-I --, \_~!:~'L AGGREGATE ;~~~ AP~S PER: i I POLICY :-1 JECT r I LOC ! AUTOMOBILE LIABILITY B:. ANY AUTO r ALL OWNED AUTOS f" I __ SCHEDULED AUTOS [j HIRED AUTOS i ! NON.QWNED AUTOS ,"---j r1......-...".."..-.---.- !..GA.!'AGE LIABILITY i i ANY AUTO !----< , I I ! POLICY NUMBER I PD'i'r~1r.f~rJ8~E ! PgkfEV;~b~C:N LIMITS ...- EACHOCCURRENCE~_JS 2,000,000 02/05/06 02/05/07 ~~~'ES(Eaoccull!~$50!000 MED EXP (Anyone person) $ 2 , 0 0.0 L.~.~~~NAL ~.ADV IN,J_~RY S 2 , 000 ~_Q 0 Q_ i GENERAL AGG~EGA~_~~ ,000,000 _ I PRODUCTS. COMP/C)P AGG S 2 ,_Q..() 0 , 000 I , A 0602MFA000080 i EXCESS/UMBRELLA LIABILITY P OCCUR 0 CLAIMS MADE t"'-l DEDUCTIBLE i i RETENTION S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ~~~I~tS~~~v'i~~b~S below OTHER I I ! . i I i \ I I / i I I I , , , I I I I I I I t i I i I I I I I I I I I I ! i ! I COMBINED SINGLE LIMIT I (Ea accident) I S : SODIL Y INJURY ! (Per person) r-" I BOOIL V INJURY i (Per accident) I I PROPERTY DAMAGE (Per ae<:idenl) I ---L................----- Is ! Is I AUTO ONLY. EA ACCIDENT I s ....-.----..-......------..--........---.......... I OTHER THAN . EA ACe , $ AUTO ONt Y: AGG I $ I EACH OCCURREN?~~_.._. ! s AGGREGATE I $ L---....-----.-----4!..... I \ S Is I TORY LIMITS I IUE~.! E.L. EACH ACCICENT I S _~~ISEAS,=-:...EA E't!'!:.~~E_~L$ E.L. DISEASE. POLICY LIMIT I S ......-.-..- -.--...-.-- 02/05/061 i I DESCRIPTION OF OPERATIONS I L.OCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS This certificate serves as evidence of insurance for General Omissions Liability. A E&O Liability 0602MFAOOOOBO I 02/05/07 I I Per Claim Aggregate $2,000,000 $4,000,000 and Errors & City of Ashland-Electric Dept Attn: Scott Johnson 90 N. Mountain Ave. Ashland OR 97520 CANCELLATION CI T 3 2AS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CIl,NCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES, AUT RlZED REPRE~, @ ACORD CORPORATION 1988 CERTIFICATE HOLDER ACORD 25 (2001/08) CITY RECORDER'S COpy ,I I