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ACORD. CERTIFICATE OF LIABILITY INSURANCE OP ID D~ DATE (MMIDDNYYY)
PUBL01C 10/26/06
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
United Risk Solutions, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Formerly known as KPD Medford HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
PO Box 936 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Medford OR 97501-0067
Phone: 541-245-1111 Fax:541-245-1112 INSURERS AFFORDING COVERAGE NAlC#
INSURED INSURER A: American Econ~ Ins CO
INSURER B: Continental Casualty
Public Works Manaxement, Inc. INSURER C:
3572 N Poothill R INSURER 0:
Medford OR 97504
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.
LTR NSRr TYPE OF INSURANCE POLICY NUMBER ~~~~1MMlDDNYl P8k~E IMM/DDrM N LIMITS
~NERAL LIABILITY EACH OCCURRENCE $1,000,000
A X X COMMERCIAL GENERAL LIABILITY 02B0981313-5 11/03/06 11/03/07 PREM~ES(Eao~urenre) $ Included
I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 10,000
PERSONAL & ADV INJURY $ Included
-
- GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COM~OPAGG $ Included
I nPRO- n
POLICY JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Included
-
A ANY AUTO 02B0981313-5 11/03/06 11/03/07 (Ea accident)
-
ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
-
~ HIRED AUTOS BODILY INJURY
$
~ NON-OWNED AUTOS (Per a~ident)
I-- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
tJ OCCUR o CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND ITo~i~I~Ii's I IOJ~-
ER
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $
ANY PROPRIETOR/PARTNER/EXECUTIVE -..
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $
~~~'MtS~~~v1s1o~s below E.L. DISEASE - POLICY LIMIT $
OTHER
B Professional 254038879 11/03/05 11/03/08 $500,000 Per Claim
Liability $1000000 Ann. Agog.
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Re: Operations of the Named Insured / City of Ashland is Additional
Insured per Endt. #BP7057 (07/02) attached.
CERTIFICATE HOLDER
CANCELLATION
CITAS01
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,
E lYE
City of Ashland
20 E Main
Ashland OR 97520
RECE~\lFD
OCT 2 6 20G~
ACORD 25 (2001/08)
@ACORD CORPORATION 1988
.... R[PRINT
,~ THE ARCHI'IE THE CRIGII,AL TRANSACTION I.IAY INCLJDE AD
AL FORL1S *...
; .
BUSINESSOWNERS
BP 70 57 0702
THIS ENDORSEMENT
CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS COVERAGE FORM - Section II - Liability
SCHEDULE'
Name of Person or Organization:
WHO IS AN INSURED (Section C) is amended to include as an insured the person or organization shown in
the Schedule as an insured but only with respect to liability arising out of your operations or premises owned
by or rented to you.
* Information required to complete the Schedule, if not shown on this endorsement, will be shown in the
Declarations.
BP 70 57 07 02
Saleco <!J and the Sale co logo are trademarks 01 Saleco Corporation
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AJP -I~E 1.'.2. 20-PR INTOO 1-0 7 63-0013-1