HomeMy WebLinkAboutInsurance Certificate: Cut N Break Construction
A CORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY)
4/11/2008
PRODUCER (541) 772-1111 FAX: (541)772-3785 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
JBL&K Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
707 Murphy Rd ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Medford OR 97504 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: American Hallmark Ins Co 43494
Cut N Break Construction Inc INSURER B: SAIF Corporation
POBox 1455 INSURER c: Western Surety Company
INSURER D:
Medford OR 97501-0108 INSURER E:
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.
N::r.REI::ATE L1MIT~ ~H()WN MAY HAVE BEEN REDUCED BY PAID I'LAIMS.
INSR ADD'L P~..t+~~:~~6g~r Pgi!fl/~~~t~N LIMITS
TYPE OF INSURANCE POLICY NUMBER
~NERAL LIABILITY EA~H ()~~II RRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY ~~~~H?E~~~~~~n~~\ $ 100,000
A I CLAIMS MADE [!] OCCUR 44CL44930201 4/13/2008 4/13/2009 MED EXP (Anv one Derson\ $ 5,000
- PERSONAL & ADV INJURY $ 1,000,000
- GENERAL AGGREGATE $ 2,000,000
~'L AGGREnE LIMIT nES PER: PRODUCTS - COMP/OP Ar.r. $ 2,000,000
X POLICY ~bWT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
- $
~ ANY AUTO (Ea accident)
A ALL OWNED AUTOS 44CL44930201 4/13/2008 4/13/2009 BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
I--
>-- HIRED AUTOS BODILY INJURY $
NON-OWNED AUTOS (Per accident)
I--
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EA A~~ $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY $
tJ OCCUR D CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
B WORKERS COMPENSATION AND I T~~~I~J~s I IOJ~-
EMPLOYERS' LIABILITY 500,000
ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? 489003 1/1/2008 1/1/2009 E.L. DISEASE - EA EMPLOYEE $ 500,000
~~~61~~s~~~~~~~~s below EL DISEASE - POLICY LIMIT $ 500,000
C OTHER PREVAILING WAGE BOND 70106243 6/5/2007 6/5/2008 BOLl BOND 30,000
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Re: Verification of Insurance
This form is subject to policy terms, conditions. and exclusions.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of Ashland EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
Kari Olson 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
90 N Mount~-N ORDER -
Ashland, 0 . cREe i FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER,ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE ~~
K Edwards/KIMED
-- --,-.-..---- ---..- -.
ACORD 25 (2001/08)
INS025 (0108).08a
@ ACORD CORPORATION 1988
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