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Home My WebLink AboutWelburn Electric salFCORPORATION 400 High Street SE Salem, OR 97312-1000 Toll Free 1-800-285-8525 OREGON WORKERS COMPENSATION CERTIFICATE OF INSURANCE MAIL TO: CERTIFICATE HOLDER: CITY OF ASHLAND 20 E. MAIN STREET ASHLAND, OR 97520 CITY OF ASHLAND 20 E. MAIN STREET ASHLAND, OR 97520 The policy of insurance listed below has been issued to the insured named below for the policy period indicated. The insurance afforded by the policy described herein is subject to all the termfll~xclusions and conditions of such policy. . _. :;'fl'ro: . POLICY PERIOD 1~::>Ut: UA It: 488390 01/01/2007 to 01/01/2008 01/26/2007 INSURED: BROKER OF RECORD: WELBURN ELECTRIC INC PO BOX 329 PHOENIX, OR 97535-0329 I LIMITS OF LIABILITY Bodily Injury by Accident $500,000 each accident Bodily Injury by Disease $500,000 each employee Bodily Injury by Disease $500,000 policy limit DESCRIPTION OF OPERATIONS/LOCATIONS/SPECIAL ITEMS: IMPORTANT: The coverage described above is in effect as of the issue date of this certificate. It is subject to change at any time in the future. This certificate is issued as a matter of information only and confers no rights to the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policies above. AUTHORIZED REPRESENTATIVE ~r-- INSURED --Tl ACORD", CERTIFICATE OF LIABILITY INSURANCE OP 10 L~ DATE (MM/DDNYYY) WELBU-1 12/17/07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Protectors Insurance, LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Pilot Rock Ins Agency LLC (CA) HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR PO Box 4669 AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Medford OR 97501 Phone: 541-773-5358 Fax:541-772-1906 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: North Pacific INSURER B: Welburn Electric Inc INSURER c: PO Box 329 INSURER 0: Phoenix OR 97535 INSURER E: CANCELLATION CITYAS2 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. ~PR 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. L TR NSRC TYPE OF INSURANCE POLICY NUMBER GENERAL LIABILITY '--- X COMMERCIAL GENERAL LIABILITY C15127353 =0 CLAIMS MADE ~ OCCUR PD~~'(PiMrDCD'rW)c P8kr"ET (iMjb1rrf!t~N A EACH OCCURRENCE UAMAut: I U Kt:N I t:u PREMISES (Ea occurence) MED EXP (Anyone person) 12/23/07 12/23/08 A ~ GEN'L AGGREGATE LIMIT APPLIES PER: n POLICY n ~r8T n LOC AUTOMOBILE LIABILITY .--- ~ ANY AUTO C15127353 ALL OWNED AUTOS PERSONAL & ADV INJURY' GENERAL AGGREGATE PRODUCTS - COMP/OP AGG 12/23/07 COMBINED SINGLE LIMIT 12/23/08 (Ea accident) SCHEDULED AUTOS BODILY INJURY (Per person) - HIRED AUTOS NON-OWNED AUTOS BODILY INJURY (Per accident) ~ PROPERTY DAMAGE (Per accident) GARAGE LIABILITY R ANY AUTO EXCESS/UMBRELLA LIABILITY ~ OCCUR D CLAIMS MADE AUTO ONLY - EA ACCIDENT OTHER THAN AUTO ONLY: EACH OCCURRENCE AGGREGATE ~ DEDUCTIBLE ~ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below OTHER I TORY LIMITS I I OJ~- E.l. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER City of Ashland 20 E Main Str Ashland OR 97520 ACORD 25 (2001/08) LIMITS $1,000,000 $100,000 $ 5,000 $1,000,000 $2,000,000 $2,000,000 $1,000,000 $ $ $ $ EA ACC $ $ $ $ $ $ $ AGG @ACORD CORPORATION 1988