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ACQRD'M CERTIFICATE OF LIABILITY INSURANCE J DATE (MM/DDIYYYY)
A f'\1'\f'\1 IA ,a 007
PRODUCER (541) 772-1111 FAX: (541) 772-3785 THIS CERTIFICATE IS ISSUE~!lllll JiIII D'F\. TION
JBL&K Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
707 Murphy Rd ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Medford OR 97504 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A Uni trin Preferred 25909
Ashland Construction, Inc. INSURER B:
dba: Southern Oregon Concrete Pumping INSURER C
215 Water Street INSURER D
Ashland OR 97520 INSURER E
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.
AGt;REGATE LIMITS SHOWN MAY HAVE RFEN REnllr.ED BY PAID r.1 AIMS.
INSR ADD'L P~l-+~~~~i~g~~ Pg~I.fJI~~~~N LIMITS
TYPE OF INSURANCE POLICY NUMBER
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
- ~~~~*~J9E~~~J';~nce\
X COMMERCIAL GENERAL LIABILITY $ 100,000
A I CLAIMS MADE GU OCCUR CAP2502463 3/21/2007 3/21/2008 MED EXP (Anv one Derson\ $ 10,000
PERSONAL & ADV IN IIRY $ 1,000,000
- 2,000,000
- GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP Ar.r. $ 2,000,000
Xl POLICY n ~rPT n LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
- (Ea aCCident) $
X ANY AUTO
r-- 3/21/2008
A ALL OWNED AUTOS CAP2502463 3/21/2007 BODILY INJURY
r-- (Per person) $
SCHEDULED AUTOS
-
- HIRED AUTOS BODILY INJURY $
(Per aCCident)
- NON-OWNED AUTOS
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EAACr. $
AUTO ONLY AGG $
EXCESS/UMBRELLA LIABILITY $
o OCCUR D CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I T";!',r,-1T fiII'i-" I IOJ~-
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? E L DISEASE - EA EMPLOYEE $
If yes, describe under E.L. DISEASE - POLICY LIMIT $
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
This form is subject to policy terms, conditions, and exclusions.
RECEtVED
MAR 2 8 Z007
CERTIFICATE HOLDER
CANCELLA TION
City of Ashland
20 E Main Street
Ashland, OR 97520
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
10 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.
AUTHORIZED REPRESENTATIVE
~Q~~
ACORD 25 (2001/08)
INS025 (0108) 08a
e Damstra Lepley, ere
@ACORDCORPORATION 1988
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