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Home My WebLink AboutInsurance Certificate: Pathway Enterprises saiFcorporation 400 High Street SE Salem, OR 97312-1000 Toll Free 1-800-285-8525 OREGON WORKERS COMPENSATION CERTIFICATE OF INSURANCE efTY RECOqDf:A '..J '-"'oJ. ,.. .- MAIL TO: CERTIFICATE HOLDER: CITY OF ASHLAND A TT KARl OLSON 90 N MOUNTAIN ASHLAND, OR 97520 CITY OF ASHLAND A TT KARl OLSON 90 N MOUNTAIN ASHLAND, OR 97520 The policy of insurance listed below has been issued to the insured named below for the policy period indicated. The insurance afforded by the policy described herein is subject to all the terms exclusions and conditions of such policy. POLICY NO. 524679 INSURED: PATHWAY ENTERPRISES 722 JEFFERSON AVE ASHLAND, OR 97520 POLICY PERIOD ISSUE DATE 04/01/2008 to 04/01/2009 04/02/2008 BROKER OF RECORD: RUSS SCHWEIKERT 801 O'HARE PARKWAY #101 MEDFORD, OR 97504 LIMITS OF LIABILITY Bodily Injury by Accident $500,000 each accident Bodily Injury by Disease $500,000 each employee Bodily Injury by Disease $500,000 policy limit DESCRIPTION OF OPERATIONS/LOCATIONS/SPECIAL ITEMS: IMPORTANT: The coverage described above is in effect as of the issue date of this certificate. It is subject to change at any time in the future. This certificate is issued as a matter of information only and confers no rights to the certificate holder. This certificate does not aniend, extend or altE:r the coverage afforded by ihe policje~ above. AUTHORIZED REPRESENTATIVE Cl~1-=:> r---- INSURED ACORD.. CERTIFICATE OF LIABILITY INSURANCE OP 104M I DATE (MM/DDIYYYY) PATHW 1 05/15/08 ~RQDUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Western States Ins. - Medford HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 739 Medford Center ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Medford OR 97504 Phone: 541-779-1321 Fax:541-779-9187 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Granite State Insurance INSURER B: National Union Fire Ins pathwat Enterprises, Inc. INSURER C: 722 Je ferson Ave INSURER D: Ashland OR 97520 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. LTR NSR[ TYPE OF INSURANCE POLICY NUMBER PD~,;!~1rf~rJ&~E PgkWl(~M%~~N LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 f---- A X X COMMERCIAL GENERAL LIABILITY 02LX0050599374000 05/11/08 05/11/09 P~~~S(Ea~Uffin~) $ 200,000 r-- I CLAIMS MADE [!] OCCUR MED EXP (Anyone person) $ 10000 PERSONAL & ADV INJURY $1,000,000 ~- -----_._-----~-_.- X Professional Liab GENERAL AGGREGATE $ 3,000,000 r-- GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 3,000,000 n 'nPRO- n Emp Ben. 1mil/1 mil POLICY JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT f---- $1,000,000 A X X ANY AUTO 02CA0062675284000 05/11/08 05/11/09 (Ea accident) r-- ALL OWNED AUTOS BODILY INJURY f---- $ SCHEDULED AUTOS (Per person) r-- HIRED AUTOS BODILY INJURY r-- $ NON-OWNED AUTOS (Per accident) f---- r-- PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ R ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 3,000,000 B X ~ OCCUR D CLAIMS MADE 29UD0046599734000 05/11/08 05/11/09 AGGREGATE $ 3,000,000 $ ~ DEDUCTIBLE $ . X RETENTION $10.000 $ WORKERS COMPENSATION AND I TORY LIMITS I IU!H- ER EMPLOYERS' LIABILITY $ ANY PROPRIETORlPARTNERlEXECUTIVE E.L. EACH ACCIDENT OFFICERlMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E. L. DISEASE - POLICY LIMIT $ SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Certificate holder is additional insured. CITY RECORDER CERTIFICATE HOLDER CANCELLATION Ci ty of Ashland Attn: Kari Olson 90 N Mountain Ashland OR 97520 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. A RIZED RE RESE ACORD 25 (2001/08) ~/G