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ACORDTM CERTIFICA TE OF LIABILITY INSURANCE OP ID 3~ DATE (MM/DDNYYY)
CHOWN-3 01/05/09
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Fullerton & Company HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P. O. Box 29018 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Portland OR 97296-9018
Phone: 503-274-6511 Fax:503-274-6524 INSURERS AFFORDING COVERAGE NAIC#
INSURED --
INSURER A: SAIF Corporation
INSURER B:
Xen 1, Inc. INSURER C:
Xenium Resources
7401 SW Washo Ct S#200 INSURER D:
Tualatin OR 97062
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.
NSRC POLICY NUMBER PD~I;!~1J~rJ8~E PQLL~Y EXPt~-g,~N LIMITS
LTR TYPE OF INSURANCE DATE" (MM/DDIYY
GENERAL LIABILITY EACH OCCURRENCE $
- U""IVI""~I: I U 1'\1:1'4 II:U
COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurence) $
I CLAIMS MADE D OCCUR MED EXP (Anyone person) $
1---------,-- ---.----..--.---------..-
PERSONAL & ADV INJURY $
I--
GENERAL AGGREGATE $
I--
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $
n n PRO- nLOC
POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $
ANY AUTO (Ea accident)
- ---
ALL OWNED AUTOS BODILY INJURY
- (Per person) $
SCHEDULED AUTOS
-
HIRED AUTOS BODILY INJURY
I-- $
NON-OWNED AUTOS (Per accident)
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
1 ANY 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 X I VVIj STATl..I~ I IUE~-
TORY LIMITS
A EMPLOYERS' LIABILITY 949996 01/01/09 01/01/10 EL EACH ACCIDENT $ 1,000,000 __
ANY PROPRIETOR/PARTNER/EXECUTIVE
, OFFiCERfMfMBER eXCLUDED? E.L.D1SEASE - EA EMPLOYEE $ 1,000,000
If yes, describe under E.L. DISEASE - POLICY LIMIT $ 1,000,000
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
As respects the operations of Chown, Inc. 333 NW 16th Ave, Portland OR,
97209
CERTIFICATE HOLDER
CANCELLA TION
CITYASH
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO
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
City of Ashland
Kari Olson
90 North Mountain
Ashland OR 97520
@ ACORD CORPORATION 1988
ACORD 25 (2001/08)