HomeMy WebLinkAboutInsurance Certificate: Welburn Electric
ACORD.. CERTIFICATE OF LIABILITY INSURANCE OP ID KS I DATE (MMlDDIYYYY)
WELBU-1 12/24/08
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Protectors Insurance, LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Pilot Rock Ins Agency LLC (CA) HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
PO Box 4669 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Medford OR 97501
Phone: 541-773-5358 Fax:541-772-1906 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: North Pacific
INSURER B:
Welburn Electric Inc INSURER c:
PO Box 329 INSURER D:
Phoenix OR 97535
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.
II...;)" ~SR[ POLICY NUMBER PD~,;!~1MMlDD#if I P8ktl.;ET(MMlDDrfY)' LIMITS
LTR TYPE OF INSURANCE
GENERAL LIABILITY EACH OCCURRENCE $1,000,000
~ ~~~a~~s (E~~~~~nce)
A X COMMERCIAL GENERAL LIABILITY C16127353 12/23/08 12/23/09 $ 100,000
I CLAIMS MADE [!] OCCUR MED EXP (Anyone person) $ 5,000
PERSONAL & ADV INJURY $1,000,000
I--
GENERAL AGGREGATE $2,000,000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000
Xl n PRO- nLOC
X POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000
-
A X ANY AUTO C16127353 12/23/08 12/23/09 (Ea accident)
I--
ALL OWNED AUTOS BODILY INJURY
I-- (Per person) $
SCHEDULED AUTOS
I--
HIRED AUTOS BODILY INJURY
I-- $
NON-OWNED AUTOS (Per accident)
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R IWY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
o OCCUR D CLAIMS MADE AGGREGATE $
$
=1 DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND IT~~l~I~Ws 1 IU1H-
ER
EMPLOYERS' LIABILITY E.L EACH ACCIDENT $
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $
If pes, describe under E.L DISEASE - POLICY LIMIT $
S ECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
CERTIFICATE HOLDER
City of Ashland
20 E Main Str
Ashland OR 97520
CANCELLATION
CITYAS2 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.
AUTHORIZED REPRESENTAT
@ ACORD CORPORATION 1988
ACORD 25 (2001/08)
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