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ACORQM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY)
03/22/2006
PRODUCER (541)857-0679 FAX (541)857-9883 THIS CERTIFICATE IS ISSUED AS A MAlTER OF INFORMATION
Ashland Insurance, Inc. - 0 'l\)~G ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
801 O'Hare Parkway, Ste 101 c. f\~R 'L ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Medford, OR 97504 REC\:.\ ~ i.-~
INSURERS AFFORDING COVERAGE NAIC#
INSURED Ashland Construction, Inc. INSURER A: Financial Pacific
DBA: Southern Oregon Concrete Pu~ing INSURER B:
102 Pleasant View INSURER c:
Talent, OR 97540 INSURER D:
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 QTHER 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 P~l-~~i~~~8~f Pg~1fJI~~J,Rif~N LIMITS
LTR
GENERAL LIABILITY 172017A 03/21/2006 03/21/2007 EACH OCCURRENCE $ 1,000,000
-
X COMMERCIAL GENERAL LIABILITY ~~~~~~J9E~~:!.~~n .\ $ 100,000
I CLAIMS MADE 00 OCCUR MED EXP (Anyone person) $ 5,000
A PERSONAL & ADV INJURY $ 1.000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000
I .nPRO- n
POLICY JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- (Ea accident) $
ANY AUTO
-
ALL OWNED AUTOS BODILY INJURY
- (Per person) $
SCHEDULED AUTOS
f---
HIRED AUTOS BODILY INJURY
f--- (Per accident) $
NON-OWNED AUTOS
f---
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - 81. ACCIDENT $
==i ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
=:J OCCUR o CLAIMS MADE AGGREGATE $
$
==i DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I TORY liMn's I IOJ~-
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $
If '(,es. describe under E.L. DISEASE - POLICY LIMIT $
S ECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
CITY RECORDER'S CC)PY
City of Ashland
20 E Main Street
Ashland, OR 97520
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSUREI~ WILL ENDEAVOR TO MAIL
JL DAYS ~ITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTA~ ^
Marcia Pollman J Y I
@ACORDCORPORATION 1988
CERTIFICATE HOLDER
ACORD 25 (2001/08)
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