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Home My WebLink AboutPathway Enterprises saifcorporation 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 A TT KARl OLSON 90 N MOUNTAIN ASHLAND, OR 97520 CITY OF ASHLAND A TT KARl OLSON 90 N MOUNTAIN 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 terms exclusions and conditions of suc!l.Qglicy. POLICY NO. 524679 INSURED: PATHWAY ENTERPRISES 722 JEFFERSON AVE ASHLAND, OR 97520 POLICY PERIOD ISSUE DATE 04/01/2007 to 04/01/2008 04/13/2007 BROKER OF RECORD: ASHLAND INS (MEDFORD) 801 O'HARE PARKWAY SUITE 101 MEDFORD, OR 97504 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 OPERA TIONS/LOCA TIONS/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-- CITY RECORDER'S COpy INSURED ACORD_ CERTIFICATE OF LIABILITY INSURANCE OP 10 1~ DATE (MMlDDIYYYY) PATHW-l 05/14/07 PROOUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Western States Ins. - Medford HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 739 Medford Center ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Medford OR 97504 Phone: 541-779-1321 Fax: 541-779-9187 INSURERS AFFORDING COVERAGE NAlC# INSURED INSURER A: Granite State Insurance INSURER B: National Union Fire Ins pathwaI Enterprises, Inc. INSURER C: 722 Je ferson Ave INSURER 0: Ashland OR 97520 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. ~~ POlICY NUIIBER I~ UMITS TYPE OF INSURANCE DATE IIM1DD/YY) DATElliIMID GENERAL UABlUTY EACH OCCURRENCE $ 1,000,000 I--- A X ~ COMMERCIAl GENERAL lIABilITY 02LX50599373000 05/11/07 05/11/08 PREMISES (Ea occurence) $200,000 f-- =:J ClAIMS MADE ~ OCCUR MED EXP (Anyone pen;on) $ 10000 PERSONAl & ADV INJURY $ 1,000,000 - ~ Professional Liab GENERAL AGGREGATE $ 3,000,000 GEN'l AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 3,000,000 Xl n PRO- nlOC Emp Ben. lmil/l mil X POLICY JECT AUTOMOBILE UABlUTY COMBINED SINGLE liMIT $1,000,000 - A X X ANY AUTO 02CA62675283000 05/11/07 05/11/08 (Ea accident) - All OWNED AUTOS BODilY INJURY - $ SCHEDULED AUTOS (Per pen;on) - HIRED AUTOS BODilY INJURY - $ NON-OWNED AUTOS (Per accident) - - PROPERTY DAMAGE $ (Per accident) GARAGE UABlUTY AUTO ONLY - EA ACCIDENT $ ==] ANY AUTO OTHER THAN EAACC $ AUTO ONLY: AGG $ EXCESSlUlIBREllA UABlUTY EACH OCCURRENCE $3,000,000 B X ~ OCCUR D ClAIMS MADE 290046599733000 05/11/07 05/11/08 AGGREGATE $ 3,000,000 $ ~ DEDUCTIBLE $ X RETENTION $10,000 $ WORKERS COMPENSATION AND IT~Y:;~~WS I lu~{t EMPLOYERS' tJA8lllTY E.l. EACH ACCIDENT $ ANY PROPRIETORIPARTNERlEXECUTIVE OFFICERlMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYE E $ If~. desaibe under E.L. DISEASE - POLICY LIMIT $ S ECIAl PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I lOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Certificate holder is additional insured. CITY RFt;opn~q'l~ rf"'\P'f . '__' ,.. , 1.... ~ ...) "-' '--' . _ CERTIFICATE HOLDER Ci ty of Ashland Attn: Kari Olson 90 N Mountain Ashland OR 97520 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOlDER NAIlED TO THE LEFT, BUT FAILURE TO DO so SHALL IMPOSE NO OBLIGATION OR UABlUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ACORD 25 (2001/08) ~/G