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ACORDN CERTIFICATE OF LIABILITY INSURANCE OP ID 3" DATE (MMlDD/YYYY)
CHOWN-3 01/02/08
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Fullerton & Company HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P. O. Box 29018 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Port1and OR 97296-9018
Phone: 503-274-6511 Fax:503-274-6524 INSURERS AFFORDING COVERAGE NAlC#
INSURED INSURER A: SAIF Corporation
INSURER B:
Xen 1 Client #950928 INSURER C:
Xenium Resources
7401 SW Washo Ct S#200 INSURER D:
Tualatin OR 97062
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.
I~~~ NS'Rc TYPE OF INSURANCE POLICY NUMBER ~~~~lJ~6'&Wi1: 1'!:cl~Ll;.r(~b'1f~N LIMITS
.::..'~ DATE MMlDDIYY
GENERAL LIABILITY EACH OCCURRENCE $
r-- PR~lS~s (Ea occurence)
COMMERCIAL GENERAL LIABILITY $
r-- ~ CLAIMS MADE D OCCUR
MED EXP (Anyone person) $
r--
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $
n .nPRO- n
POLICY JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
I - $
ANY AUTO (Ea accident)
r--
ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
r--
HIRED AUTOS BODILY INJURY
f--- $
NON-OWNED AUTOS (Per accident)
I--
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
tJ OCCUR D CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND X I TORY LIMITS i IU.!H-
ER
A EMPLOYERS' LIABILITY 949996 01/01/08 01/01/09 $1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $1,000,000
If ~es, describe under $1,000,000
S ECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
As respects the operations of Chown, Inc. 333 NW 16th Ave, Portland OR,
97209.
Verification of Insurance. CITY RECORDER
CERTIFICATE HOLDER
City of Ashland
90 North Mountain
Ashland OR 97520
CANCELLATION
CITYASH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 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
REPRESENTATIVES.
AUTHORIZ REPRE(!~A~
@ACORD CORPORATION 1988
ACORD 25 (2001/08)