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CERTIFICATE OF LIABILITY INSURANCE
RECEIV
OCT III
CSR KS DATE (MMIDDIYYYY)
METAL-1 10 11 06
ttlS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
LY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
LDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PRODUCER
Protectors Insurance, LLC
Pilot Rock Ins Agency LLC (CA)
PO Box 4669
Medford OR 97501
Phone: 541-773-5358 Fax:541-772-
INSURED
NAIC#
Metal Masters Inc
3825 Crater Lake Hwy
Medford OR 97504
A.
~INSURER B:
I INSURER C:
I INSURER 0
. INSURER E.
SAIF Corporation
Liberty Northwest Insurance
41939
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.
NSRC POLICY NUMBER P.UL1C;Y.~.l:r_ECT!l)t: POLlCY(~XPIRAJ!...~N LIMITS
LTR TYPE OF INSURANCE DATE iMM/DDIYY DATE MM/DDIYY
GENERAL LIABILITY EACH OCCURRENCE $1,000,000
-
B X COMMERCIAL GENERAL LIABILITY C13150259 10/01/06 10/01/07 PREMISES (Ea occurence) $ 100,000
I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 5,000
I $1,000,000
PERSONAL & ADV INJURY
-
GENERAL AGGREGATE $2,000,000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS. COMP/OP AGG $2,000,000
Xl n PRO. nLOC
X POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000
-
B ~ ANY AUTO C13150259 10/01/06 10/01/07 (Ea accident)
ALL OWNED AUTOS BODILY INJURY
- (Per person) $
SCHEDULED AUTOS
--
HIRED AUTOS BODILY INJURY
- I (Per accident) $
NON.OWNED AUTOS
-
I PROPERTY DAMAGE
- ! (Per accident) $
GARAGE LIABILITY I AUTO ONLY. EA ACCIDENT $
==1 ANY AUTO I
I EA ACC $
i OTHER THAN
AUTO ONLY. AGG $
I $
EXCESS/UMBRELLA LIABILITY I EACH OCCURRENCE
:=J OCCUR D CLAIMS MADE I AGGREGATE $
I $
=l DEDUCTIBLE I $
RETENTION $ $
WORKERS COMPENSATION AND X I TORY L1Mm; I IU.lr.
ER
A EMPLOYERS' LIABILITY 812256 10/01/06 . 10/01/07 , Fl.. EJI.CH A<::CIDENT ~ 500,000
ANY PROPRIETOR/PARTNERlEXECUTlVE - - . I
OFFICERlMEMBER EXCLUDED? I E.L DISEASE. EA EMPLOYEE $ 500,000
If yes, describe under EL. DISEASE. POLICY LIMIT $ 500,000
SPECIAL PROVISIONS below
OTHER !
I
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
CERTIFICATE HOLDER
CANCELLA TION
CITYASH
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
City of Ashland
City Hall
Ashland OR 97520
@ ACORD CORPORATION 1988
ACORD 25 (2001/08)