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Home My WebLink AboutWelburn Electric salFCORPORATION 400 High Street SE Salem, OR 97312-1000 Toll Free 1-800-285-8525 OREGON WORKERS COMPENSATION CERTIFICATE OF INSURANCE MAIL TO: CERTIFICATE HOLDER: CITY OF ASHLAND 20 E. MAIN STREET ASHLAND, OR 97520 CITY OF ASHLAND 20 E. MAIN STREET ASHLAND, OR 97520 The policy of insurance listed below has been issued to the insured named below for the policy period indicated. The insurance afforded by the policy described herein is subject to all the terms exclusions and conditions of such olic. POLICY NO. 488390 INSURED: WELBURN ELECTRIC INC PO BOX 329 PHOENIX, OR 97535-0329 POLICY PERIOD ISSUE DATE 01/01/2006 to01/01/2007 12/27/2005 BROKER OF RECORD: LIMITS OF LIABILITY Bodily Injury by Accident $500,000 each accident Bodily Injury by Disease $500,000 each employee Bodily Injury by Disease $500,000 policy limit DESCRIPTION OF OPERATIONS/LOCATIONS/SPECIAL ITEMS: IMPORTANT: The coverage described above is in effect as of the issue date of this certificate. It is subject to change at any time in the future. This certificate is issued as a matter of information only and confers no rights to the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policies above. AUTHORIZED REPRESENTATIVE ~r-- CITY RECORDER'S COpy INSURED PRODUCER Protectors Insurance, Pilot Rock Ins Agency PO Box 4669 Medford OR 97501 Phone: 541-773-5358 LLC LLC (CA) Y INSURANCE OP 10 DATE (MMlDDIYYYY) WELBU-l 12 22 06 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ~URERS AFFORDING COVERAGE NAIC # INSURER A: Orellon Automobile lnsurance Co 23922 INSURER B: INSURER C: INSURER 0: INSURER E: ACORD",'CERTIFICA TE 'Fax: 541-7ACCQ~NTS PAYA INSURED Welburn Electric Inc PO Box 329 Phoenix OR 97535 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. LTR NSRi TYPE OF INSURANCE POLICY NUMBER DA'i'e 1MM/DDlY'il" DATE MM/DDIYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 - 12/23/06 12/23/07 . ~R~:S~S (E~~~~~nce) A X X COMMERCIAL GENERAL LIABILITY C14127353 $ 100,000 I CLAIMS MADE [!] OCCUR MED EXP (Anyone person) $ 5,000 PERSONAL & ADV INJURY $1,000,000 - GENERAL AGGREGATE $ 2,000,000 - $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS. COMP/OP AGG h .nPRO. n POLICY JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT I- (Ea accident) $ ANY AUTO I- ALL OWNED AUTOS BODILY INJURY $ I- (Per person) SCHEDULED AUTOS I- HIRED AUTOS BODILY INJURY $ I- (Per accident) NON.OWNED AUTOS l- I- PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $ R ANY A4TO' OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ tJ OCCUR o CLAIMS MADE AGGREGATE $ $ R DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND ITORY LIMITS I IU~~' EMPLOYERS' LIABILITY E.L EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? E.L DISEASE - EA EMPLOYEE $ If yes, describe under .. E.L. DISEASE - POLICY LIMIT $ SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER Ci ty of,. Ashland 20 E. Main Street Ashland OR 97520 CANCELLATION CITYAS2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 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 DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. ~PR @ ACORD CORPORATION 1988 ACORD 25 (2001/08)