HomeMy WebLinkAboutInsurance Certificate: Evergreen Job & Safety
n2!22!2008 18 33 FAX
2022834001
HAYS OF DC
~001/001
ACORD
CERTIFICATE OF LIABILITY INSURANCE
OP ID UB DM!: (MMiDDNYY'r)
EVERG-2 02 22 08
THIS C~RTIFICATE 15 ISSUED P.S A MATTE-R OF INFORMATION
ONL.,Y AND CONFERS NO RIGHTS UPON 'TIiE CERTIFICATE
HOLDEr~. THIS CERl'IFICA'fE DOES NOT AMEND, EXTEND OR
ALTER lliE C;OVERP.GE AFFORDED BY THE POLICIES BELOW.
rflOf>L1Cfl1
I'lays Affin:i.ty Solutions
1133 20th ~:t. N.W., Suite 450
Washington DC 20036
Phone 202-263-4000
Fax:202-263-4001
· INSURERS AFFORDING COVERAGE
: NA1C#
Evcrqrcon Job & safety
Training
Douglas Lindstrom
30S,' Knoch Avenue
Su~anville CA 96130
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Th~$ Certit'icato of Insurance serves only as evidence of Professional
/ General l.labili ty cov0rag"~.
(E&O)
CERTIfiCATE HOLDER CANCELLATION
4."'~"'_"""''''''''''''' ~_............_..
City of Ashland-Eloctric Dep~
Attn: Scott Johnson
90 ~, Mountain Avo.
Ashland. OR .97520
CI't32AS ,,;>I()l)u) ANY or HIE AllOIIC DESCRIBED l'OLlCIt,S HI:; CANCH.I.F'lJ I'H'OHf nil:' [Xr'lflATION
DATC T~lCR[OF. TI1E ISSUING INSlJRri.l~ WiLl. l:"NrWAvOI< TO MAIL 30 O/\Y(; WI<IT'ITN
NOTICe TO HIE GE.lHIFlCATr: H(H.O('R NAI\iIH) TO Hll Lcn, OUT I'AIUJREIO DO SO l;H"'ll,
IMPOf,E NO nrHlr.ATI(JN (If< UAI>lUTY or ANY KIND L1F'ON THE INSURH<.I1~ AC,!;NT~; PH
\"H:.'flL~;r;.NTA IIV\,:S.
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l(] ACORD CORPORATION 1988
ACORD 25 {2001/D(l1
CITY RECORDER
ACORDN CERTIFICATE OF LIABILITY INSURANCE OP ID ual DATE (MM/DDIYYYY)
EVERG-2 02/22/0a
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Hays Affinity Solutions HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1133 20th St. N.W. , Suite 450 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Washington DC 20036
Phone: 202-263-4000 Fax:202-263-4001 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Lloyds of London
Eve~g~een Job & Safety INSURER B:
Tra~n~ng INSURER C:
Douglas Lindstrom
309 Knoch Avenue INSURER D:
Susanville CA 96130
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 MAYBE 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 ~~~i POLICY NUMBER PD<1';l~1J~rJ.r~E Pgk!fl(~~b~,mN LI MITS
LTR TYPE OF INSURANCE
GENERAL LIABILITY EACH OCCURRENCE $2,000,000
'--
COMMERCIAL GENERAL LIABILITY UAM"\ot: $ 50,000
PREMISES (Ea occurence)
X I CLAIMS MADE D OCCUR MED EXP (Anyone person) $2,000
A X General Liability Oa02MFAOOOOaO 02/05/0a 02/05/09 PERSONAL & ADV INJURY $2,000,000
- GENERAL AGGREGATE $ 4,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000
I n PRO- nLOC
POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
'-- $
ANY AUTO (Ea accident)
'--
ALL OWNED AUTOS BODILY INJURY
f-- $
SCHEDULED AUTOS (Per person)
'--
HIRED AUTOS BODILY INJURY
f--- $
NON-OWNED AUTOS (Per accident)
f--
f-- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
~ OCCUR D CLAIMS MADE AGGREGATE $
$
~ DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I TORY LIMITS I IUJt
ER
EMPLOYERS' LIABILITY _.
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? EL. DISEASE - EA EMPLOYEE $
If yes, describe under E.L. DISEASE - POLICY LIMIT $
SPECIAL PROVISIONS below
OTHER
A E&O Liability Oa02MFAOOOOaO 02/05/0a 02/05/09 Per Claim $2,000,000
Aggregate $4,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
This Certificate of Insurance serves only as evidence of Professional (E&O)
/ General Liability coverage.
("TY nr:Cnqr)!':R
,",--I, 1'11- ..;'\.01' ... I-
CERTIFICATE HOLDER CANCELLATION
CIT32AP SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
City of Ashland Public Works
Attn: Mike Morrison
90 N. Mountain Ave.
Ashland OR 97520
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.
AUT RIZED REPRESEN
ACORD 25 (2001/08)
@ACORDCORPORATION 1988