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ACORDN CERTIFICATE OF LIABILITY INSURANCE CSR ME I DATE (MMlDDIYYYY)
9BROTPI 10/06/06
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Hart Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P. O. Box 1240 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Grants Pass OR 97528
Phone: 541-479-5521 Fax: 541-474-1890 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: AMERICAN HOME ASSURANCE
INSURER B; AMERICAN HOME ASSURANCE
Brotherton Pipeline, Inc. INSURER C; SAIF CORP
Brotherton Co~orat1on
11 South Fronta~e Road INSURER 0; ILLINOIS NATIONAL INS CO
Gold Hill OR 97 25
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 NSRI TYPE OF INSURANCE POLICY NUMBER DATE (MMlDDIYYI DATE MMlDOiYVi' LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
- 06/10/07 PREMISES (E~~~~"ce)
A X COMMERCIAL GENERAL LIABILITY 1792333 06/10/06 $ 50, OQO
I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 10,000
PERSONAL & ADV INJURY $ 1,000,000
-
GENERAL AGGREGATE $ 2,000,000
-
GEN'L AGGREGATE LIMIT APPLIES PER; PRODUCTS - COMP/OP AGG $ 1,000,000
I n PRO- nLOC
POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000
-
B X ANY AUTO 1784446 06/10/06 06/10/07 (Ea accident)
-
ALL OWNED AUTOS BODILY INJURY
- (Per person) $
SCHEDULED AUTOS
-
HIRED AUTOS BODILY INJURY
- (Per accident) $
NON-OWNED AUTOS
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
==1 ANY AUTO OTHER THAN EA ACC $
AUTO ONLY; AGG $
EXCESs/UMBRELLA LIABILITY EACH OCCURRENCE $ 1000000
D ~ OCCUR D CLAIMS MADE BE8856187 06/10/06 06/10/07 AGGREGATE $ 1000000
$
Fx=l DEDUCTIBLE $
X RETENTION $10000 $
WORKERS COMPENSATION AND X ITORY lIMln3 I IUER'
C EMPLOYERS' LIABILITY 810614 10/01/06 10/01/07 E.L. EACH ACCIDENT $ 500000
ANY PROPRIETORlPARTNERlEXECUTIVE
OFFICERlMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 500000
If ~es, describe under E.L. DISEASE - POLICY LIMIT $ 500000
S ECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
CITY RECORDER'S COpy
CERTIFICATE HOLDER
CITYASH
CANCELLATION
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 LIABI T ANY DUE INSURER, ITS AGENTS OR
CITY OF ASHLAND
PUBLIC WORKS DEPT
CARRIE
20 E. MAIN ST
ASHLAND OR 97520
/
HART INS
ACORD 25 (2001/08)
@ACORD CORPORATION 1988