HomeMy WebLinkAboutInsurance Certificate: Pacific Northwest Drilling
ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDIYYYY)
1M 05/01/2008
PRODUCER (541)687-1117 FAX (541)342-8280 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Ward Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
POBox 10167 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Eugene, OR 97440
Rob Harvey INSURERS AFFORDING COVERAGE NAIC#
INSURED Bergeson-Boese &I Associates Inc INSURER A: Hudson Specialty Ins Co
DBA: Pacific Northwest Drill ing INSURER B: Nationwide Mutual Ins Company 23787
32986 Roberts Court INSURER C: SAIF
Coburg, OR 97408 INSURER 0:
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.
l~fC ~~'?:~ TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
GENERAL LIABILITY FEC6106785 04/30/2008 04/30/2009 EACH OCCURRENCE $ 1,000 000
I--
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 50 000
I CLAIMS MADE 00 OCCUR MED EXP (Anyone person) $ 5 000
A PERSONAl & ADV INJURY $ 1 ,000 OOC
-
GENERAL AGGREGATE $ 2,000,00C
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2, 000 ,OOC
I POLICY n ~~ n LOC
AUTOMOBILE LIABILITY ACP7541541172 04/30/2008 04/30/2009 COMBINED SINGLE LIMIT
- (Ea accident) $
X ANY AUTO 1,000,000
-
ALL OWNED AUTOS BODILY INJURY
- (Per person) $
SCHEDULED AUTOS
B f--
X HIRED AUTOS BOalL Y INJURY
rx (Per accident) $
NON-OWNED AUTOS
f--
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESSlUMBRELLA LIABILITY EACH OCCURRENCE $
:J OCCUR o CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND 473858 01/01/2008 01/01/2009 I ;Xg.$'mI.~;, I IOJ~-
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ 1,000,000
C ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 1,000,000
If yes. describe under E.L. DISEASE. POLICY LIMIT $ 1,000,000
SPECiAl PROVISIONS below
OTHER FEC6106785 04/30/2008 04/30/2009 LIMIT: $1,000,000
POLLUTION LIAB
A ~ROFESSIONAL LIAB FEC6106785 04/30/2008 04/30/2009 LIMIT: $1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES f EXCLUSIONS ADDED BY ENDORSEMENT f SPECIAL PROVISIONS
IIHE CITY OF ASHLAND, ITS OFFICERS, EMPLOYEES AND AGENTS ARE ADDED AS ADDITIONAL INSUREDS IF REQUIRED BY
~RITTEN CONTRACT
ER
CA CE LATION
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 MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
CITY OF ASHLAND
20 E MAIN STREET
ASHLAND, OR 97520
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
-I~.(j.~~
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Rob Harve /CARSON
ACORD 25 (2001108)
@ACORD CORPORATION 1988