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MARSH CERTIFICATE OF INSURANCE CERTIFICATE NUMBER
NYC-001158411-22
PRODUCER RECEJVED JUN 2 3 2006 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
MARSH USA INC. NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE
ONE STATE STREET - POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
HARTFORD, CT 06103 AFFORDED BY THE POLICIES DESCRIBED HEREIN.
COMPANIES AFFORDING COVERAGE
COMPANY
23456-MCSCI-196-02-03 196 110 LHS A OLD REPUBLIC INSURANCE COMPANY
INSURED COMPANY
BUILDER SERVICES GROUP, INC. B TRAVELERS PROPERTY CASUALTY
D/B/A GALE CONTRACTOR SERVICES
2015 LARS WAY COMPANY
MEDFORD, OR 97502 C N/A
COMPANY
D
COVERAGES 2
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND EXCLUSIONS OF SUCH POLICIES. AGGREGATE
LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE (MMlDDNY) DATE (MMIDDNY)
GENERAL LIABILITY GENERAL AGGREGATE $ 5,000,000
-
A X COMMERCIAL GENERAL LIABILITY MWZV55525 06/30/06 06/30/07 PRODUCTS - COM PlOP AGG $ 10,000,000
I CLAIMS MADE [8] OCCUR PERSONAL & ADV INJURY $ 2,000,000
! - OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ 2,000,000
FIRE DAMAGE (Anyone fire) $ 2,000,000
MED EXP (Anyone person) $ 25,000
AUTOMOBILE LIABILITY $ 5,000,000
- COMBINED SINGLE LIMIT
A X ANY AUTO MWTB18398 06/30/06 06/30/07
X ALL OWNED AUTOS BODILY INJURY $
- (Per person)
X SCHEDULED AUTOS
-
X HIRED AUTOS BODILY INJURY $
- (Per accident)
X NON-OWNED AUTOS
-
- PROPERTY DAMAGE $
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
-
- ANY AUTO OTHER THAN AUTO ONLY:
EACH ACCIDENT $
-
AGGREGATE $
EXCESS LIABILITY EACH OCCURRENCE $
1 UMBRELLA FORM AGGREGATE $
OTHER THAN UMBRELLA FORM $
B WORKERS COMPENSATION AND TC2JUB 1220025-8-06 (AOS) 06/30/06 06/30/07 I WC.~A u- I IU~-
EMPLOYERS' LIABILITY X TORY LIMITS
TRJUB 122D026-A-06 06/30/06 06/30/07 EL EACH ACCIDENT $ 1,000,000
THE PROPRIETOR! ~INCL (AZ,HI,MA,OR,WI) 06/30/06 06/30/07 EL DISEASE-POLlCY LIMIT $ 1,000,000
PARTNER~EXECUTlVE TC2HUB 1210127-4-06 (MN) 06/30/06 06/30/07 $ 1,000,000
O;=FICERS ARE: EXCL EL DISEASE-EACH EMPLOYEE
I OTHER
B EXCESS WORKER'S TWXJUB 1220027-1-06 (CA,CT, 06/30/06 06/30/07 STATUTORY LIMITS
COMPENSATION DE,FL,MI,NV,NC,OH,OK,SD,TN 06/30/06 06/30/07
RETENTION $2,000,000 &WA) 06/30/06 06/30/07
DESCRIPTION OF OPERATIONS/LOCATlONSIVEHICUE~SPECIAL ITEMS
CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED WITH RESPECT TO THE PRODUCTS-COMPLETED OPERATIONS OF INSURED AS
REQUIRED BY WRITTEN CONTRACT.
CERTIFICATE HOLDER CANCEUATlON
SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF.
THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL _--3Q DAYS WRITTEN NOTICE TO THE
CITY OF ASHLAND CERTIFICATE HOLDER NAMED HEREIN, BUT FAIWRE TO MAIL SUCH NOTICE SHALL MPOSE NO OBLIGATION OR
20 EAST MAIN STREET
ASHLAND, OR 97520 LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE. ITS AGENTS OR REPRESENTATIVES, OR THE
ISSUER OF THIS CERTIFICATE.
MARSH USA INC.
BY: Donald R. Eckberg ~R.~
MM1(3f02. VAUD AS OF: 06/15/06
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