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ACORD.. CERTIFICATE OF LIABILITY INSURANCE OP ID ell DATE (MM/DDfYYYY)
PUMPP-1 10/24/07
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Monroe & Monroe Insurance Agen HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
2921 Galleria Dr., Suite 102 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Arlington TX 76011
Phone: 817-640-5035 Fax:817-640-0131 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A ~d-Continent Casualty CO.
INSURER B
Pump PiES & Tank Services INSURER C
Robert McHenry
Box 146 INSURER 0
Talent OR 97540
INSURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTQ 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
INSR AOO'L POLICY NUMBER Po'i~~~J=~fJEf~tr\E Pgk~CEYI~~6RlJ~~N LIMITS
LTR INSRD TYPE OF INSURANCE
GENERAL LIABILITY EACH OCCURRENCE $1,000,000
A X 04GL695642 11/15/07 11/15/08 DAMAGE TO RENTED $100,000
COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurence)
CLAIMS MADE X OCCUR MED EXP (Anyone person) I 0
X Pollution Liab PERSONAL & ADV INJURY $1,000,000
X Professional Liab GENERAL AGGREGATE 12,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000
X POLICY PRO- LOC
JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
I
ANY AUTO (Eaaccident)
ALL OWNED AUTOS BODILY INJURY
{Per person) I
SCHEDULED AUTOS
HIRED AUTOS BODILY INJURY
I
NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE I
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT I
ANY AUTO OTHER THAN EA ACC I
AUTO ONLY AGG I
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE I
OCCUR CLAIMS MADE AGGREGATE I
I
DEDUCTIBLE I
RETENTION I $
WORKERS COMPENSATION AND WC STATU OTH-
TORY LIMITS ER
EMPLOYERS' LIABILITY $
ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? E.L DISEASE - EA EMPLOYEE I
~p~~ltis~~rov~s~o~s below E.L. DISEASE. POLICY LIMIT I
OTHER
A Equipment Floater 04IM24844 11/15/07 11/15/0B Owned Equ 4,900
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENOORSEMENT I SPECIAL PROVISIONS
CERTIFICATE HOLDER
CANCELLATION
CASHLAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO~
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL - DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL
City of Ashland IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
20 E. Main Street
Ashland OR 97520 REPRESENTATIVES.
A~R~~A~ ~
ACORD 25 (2001/08)
@ ACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25 (2001/08)