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A CORD" CERTIFICATE OF LIABILITY INSURANCE DATE IMM/DDIYYYY)
8/27/2007
PRODUCER (541)485-6633 FAX: (541)485-3946 THIS CERTIFICATE IS ISSUED AS A MAHER OF INFORMATION
JBL&K Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
59 E 11th Ave AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PO Box 70206 I
97401 I
Eugene OR I INSURERS AFFORDING COVERAGE NAIC#
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INSURED III'URER.A North Pacific Insurance 23892
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Mountai.n View Paving Inc IIISURER E SAIF Corporation
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2560 E Main street IH<UR;::R C
Ashland, OR 97520 IIJ',URER [,
I II/'URER 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. - -----,~-~_.- -~---
IN:~ ~~~~,'I TYPC or INSURANCC POLICY NUMOCR Pgl-+~Y ~~~~g;:gJE Pg~'iJ 1~~~g';~~N LIMITS
r?ENERAL LIABiLITY ~~~:fO.REr FrED -- " - 1,000,000
r"""""'"'"'' """,n occur lel'CE' c; 100,000
A ~ CLAIMS MADE ~ JR C06154211 9/25/2007 9/25/2008 MED EXP IAn, olle oers:lI1. ';-i 5,000
I PERS'Jr',JAL &,1,["/ Ir-L1UR ( " 1,000,000
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(..:iENER6.,L ;":'(~REC--:',ATF , 2,000,000
~;f'IILA'~(;RE(;ATE LIMIT AAES PER PF~ODU<:_~TS - CCir\1F':C'FAt-:;c; 2,000,000
xl F'ULiCY n ~~2T L()C
I A,UTOMOBILE LIABILITY COI,1E,IIIED Sill,:; LE Wi IT 1,000,000
c---- (Ea accldentl ~,
~= tlNY!:O,LlTe, --
A eeL I CU6154211 9/25/2007 9/25/2008 E.iJD'L Y III.IJRY
S':HEDULED AUTOS '-Per person)
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e-- HIRED AUTOS BODIL Y II'JJIJRY
r'Jc,rJ-'")\/.!J'J~D l:.UT(',S I'PI ,)CCldelltj
e--
e-- r:-'ROPERTY DAf',ilACE
,per accident', "
GARAGE LIABILITY >\UTO OIILY EO ACCICHIT ,
=~ "'IY I OTHER TM;'II cr, A( '3
AUTO .::>r'JL 'y' ',,~';
EXCESS/UMBRELLA LIABILITY EA,CH C": :URRcl'j( E S 1,000,000
=J D "!L>\II,1S I,;;'DE AGGREGATE , 1,000,000
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A rxl DEDUCTIBLE ' C061:.4211 I 9/25/2007 9/25/2008 -.----:. --
X RET~IITnlj ,10, 000 I ,
WORKERS COMPENSA TION AND 1 ~:Xi;,.fT ~1,'rCc I ICJrt'
EMPLOYERS' LIABILITY 500 ~QQQ
>\.IIY F'RC;PRIET,JRFARTlIEREXECUTI\'E E L EilCH ACCI[;Ei'IT ~,
B ':,FFICEF</!.1Er,IE,ER EX': LUDEC'? 496578 10/1/2007 10/1/2008 E..L..Q!SE."~c_EA Ei\IPLOYEE 500,000
~},~~~ deserll)€, Ullc1el - --
IAI Pf":'C>\/ISIOI'JS belo\{\' E L D:SE'\SE. <',,' ,,-v , 11,IIT 500,000
A OTHER Equipment. Floater C06154211 9/25/2007 9/25/2008 Per Schedule
I Deductible $1,000
DESCRIPTION OF OPERATIONSILOCA TIONSIVEHICLESJEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Re; Ashl and Airport.
CERTlFICA TE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of Ashland EXPIRA TION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
90 N. Mountain 30 DAYS WRITTEN NOTICE TO THE CERTlFICA TE HOLDER NAMED TO THE LEFT, BUT
Ashland, OR 97520 -.-
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER, iTS AGENTS OR REPRESENTA T1VES.
"UTHORIZED REPRESENTATIVE
r)11 "P-r ~ f f:
,! l1 rWj.. I !,:J\_LE,'HE C/ ./JG"v; ~-:-(-/
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ACORD 25 (2001/08)
INS025
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ACORD CORPORATION 1988
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