HomeMy WebLinkAboutInsurance Certificate: Brotherton Pipeline
ACORD..
CERTIFICATE OF LIABILITY INSURANCE O:BIRo~I I DA~~M~;~
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PRODUCER
Hart Insurance
P. O. Box 1240
Grants Pass OR 97528
Phone: 541-479-5521
Fax:541-474-1890
INSURERS AFFORDING COVERAGE
Brotherton Pipe1ine, Inc.
Brotherton Co~orat1on
11 South Frontage Road
Gold Hill OR 97525
INSURER A
INSURER B
INSURER C
INSURER D
INSURER E:
Travelers Indemnity Co.
Travelers Property casualty Co
SAIF CORE'
NAIC#
10647
10647
INSURED
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 NSRC TYFE OF INSURANCE POLICY NUMBER DATE IMMlDoiWl DATE MMlDDIYVT LIMITS
GENERAL LIABILITY EACH OCCURRENCE $1,000,000
I--
A X X COMMERCIAL GENERAL LIABILITY DTC0526D9764IND07 06/10/08 06/10/09 PREMISES (E~~~~'c'u~ence) $300,000
I-- tJ CLAIMS MACE ~ OCCUR
MED EXP (Any cne person) $ 10,000
r-- $ 1,000,000
PERSONAL & NJV INJURY
r--
! GENERAL AGGREGATE $2,000,000
GE"'J'L AGGREGATE' LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $2,000,000
r-, nPRO n
: POLICY JECT LOC
! AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
f..-
B X ANY AUTO DT810526D9764TIL07 06/10/08 06/10/09 (Ea accident)
r-
ALL OWNED AlITOS BOD IL Y INJURY
- (Per person) $
SCHEDULED AUTOS
-
HIRED AUTOS BODIL Y INJURY
- (Per eccident) $
NON-OWNED AlITOS
-
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONL Y AGG $
L ~~CESS/UMBRELLA LIABILITY EACH OCCURRENCE $2,000,000
B X ! occur; o CLAIMS MACE ,DTSMCUP526D9764TILl 7 06/10/08 06/10/09 AGGREGATE $2,000,000
-~
1 $
1x-:1 DmuCT I BLE $
X RETENTION $10000 $
WORKERS COMPENSATION AND X ITORY LiMITS I IVER
C EMPLOYERS' LIABILITY 810614 10/01/07 10/01/08 EL EACH ACCIDENT $ 500000
ANY PROPRIETORIPARTNERlEXECUTIVE
OFFICER/MEMBER EXCLUDED? EL DISEASE - EA EMPLOYEE $ 500000 ./
If ye:>, describe unde( EL DiSEASE - POLICY LIMIT $ 500000
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Certificate Holder is named as Additional Insured.
CERTIFICATE HOLDER
CANCELLATION
SINGSHl SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
-
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
City of Ash1and IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Purchasing' Representative
90 N. Mountain Avenue REPRESENTATIVES.
Ash1and OR 97520 AUTHORIZED REPRESENTATIVE c>~ (?
\"'. r ,I "j ":' ., ,
Miche11e r.:.ivk1.vv'J-"'- " t l~ "
ACORD 25 (2001/08)
@ACORD CORPORATION 1988
CITY RECORDER