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CERTIFICATE OF LIABILITY INSURANCE
OP 10 Jd DATE (MM/DDIYYYY)
PACI05w'l 08/31/07
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PRODUCER
KPD Insurance, Inc.
PO Box 784
Springfield OR 97477
Phone: 541-741-0550
Fax:541-741-1674
-------'-"- - --..'--.------- ----.--------...-------- -"--
INSURED
------ -._---~--_.._-_.- -----. --- -------._--
INSURERS AFFORDING COVERAGE
NAIC#
_I~URER A__ _SAIF_C~rpora t~~ =- ~a1~_ ._
INSURER B
Pacific Paving, Inc.
PO Box 2370
White City OR 97503
- - -------- --- --------------------- - -
INSURER C
-..----.---..--- ----------.----.--- -- ---._- -.. ---._- --.---
INSURER 0
--
COVERAGES
INSURER E
-..-.---____ _._m __..________..__ __ ___ __ ____,__
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWTHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VV1TH 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
1NS~mn:------ ---- ------ ---______
l TR INSRD TYPE OF INSURANCE POLICY NUMBER
I GENERAL LIABILITY
P-OUCYEFFECTiVr POLICY EXPIRATION - - ------ -
DATE (MMIDD/YYI DATE (MM/DD/YV)
LIMITS
CLAIMS MADE
OCCUR
EACH OCCURRENCE
, lJ)\JvIJ'lGETo-RENTEU ---- ---
~PREMISE~JEilc)c(;lJI"""ceL -'-.' _ __
i MED EXP (Arlyo"" perso"L ~_ _ _ _
COMMERCIAL GENERAL LIABILITY
--I _____n_ ______... ____
, PERSONAL & AD~N.Jl)RY
I GENERAL AGGF~EGATE
_...J _____________
I GEN'L AGGREGATE LIMIT APPLIES PER
, -~ ,- PRO- ---
I POLICY , JECT LOC
1 AUTOMOBilE LIABILITY
r---,
.J ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
1-
'- J HIRED AUTOS
NON-OWNED AUTOS
---- --'-- ----------- -- --- -- -
1 PRODUCTS - COMP/OP AGG ,
"- - ----- --'-".--.---... -'-- ---- --- ---
COMBINED SINC,LE LIMIT
, (Ea aCCident)
i.-___.___._ ________
BODILY INJURY
(Per person)
I ,
I
BODILY INJURY
(Per aCCIdent)
'------ ---- ---._-
,
I
I PROPERTY DAMAGE
, (Per aCCIdent)
-r-
1 GARAGE LIABILITY
'-,
1 ANY AUTO
~ -
I
I AUTO DNL Y _ EA ACCI DENT
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! OTHER THAN
AUTO ONLY
1
EA ACC
I EXCESS/UMBRELLA LIABILITY
AGG
OCCUR
CLAIMS MADE
EACH OCCURRENCE
I AGGREGAT;- -- -
-- ---.-._------- .-- ---'---.- - ----
DEDUCTIBLE
i RETENTION
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
A 1 ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
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I
812919
10/01/07
i WC STATU- OTH-,
_XJ.IgRY IJMITI'-_._E8... _ _ _ _ _
10/01/08 ~~ACH"(;CI~EN2.._ --+ ,j:5QQ LOQ.9__
I E.L DISEASE - Ell EMPLOYEE $;;00,000
i ELDISEASE-POLlCYLlMIT S 500 000
II 'Ie;:., ue;:,~(ibt' under
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS /lOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
RE: All Operations
CERTIFICATE HOLDER
CANCELLATION
CITAS02
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE GANCEllED 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
REPRESENTA TIVES.
~&dt
City of Ashland
90 N Mountain Ave.
Ashland OR 97520
ACORD 25 (2001108)
@ACORDCORPORATION 1988
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