HomeMy WebLinkAboutInsurance Certificate: Evergreen Job & Safety
CITY Ft._-vORDER
ACORD.. CERTIFICA TE OF LIABILITY INSURANCE OP 10 U8 I DATE (MM/DDIYYYY)
EVERG-2 01/15/09
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Hays Affinity Solutions HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1133 20th st. N.W. , Suite 450 AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Washington DC 20036
Phone: 202-263-4000 Fax:202-263-4001 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A Lloyds of London
Eve;g;een Job & Safety INSURER B
Tra1n1ng INSURER C
Douglas Lindstrom
309 Knoch Avenue INSURER 0
Susanville CA 96130
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
IN>:i1'C ~R~ POLICY NUMBER PD~~~1riM/O=6'NYt Pgkt1,v(MM/DDIYY) LIMITS
LTR TYPE OF INSURANCE
GENERAL LIABILITY EACH OCCURRENCE $2,000,000
- UAMAGC I U f<tel\ll teLT
COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurence) $ 50,000
- o CLAIMS tv1J\DE "
- L OCCUR i MED EXP (Anyone person) $ 2,000
A X General Liability 0902MFAOOO080 02/05/09 02/05/10 PERSONAL & NJV INJURY $2,000,000
-
GENERAL AGGREGATE $4,000,000
-
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
- $
ANY AUTO (Ea aCCident)
>--
ALL OWNED AUTOS BODIL Y INJURY
>-- $
SCHEDULED AUTOS (Per person)
>--
HIRED AUTOS BODIL Y INJURY
>-- $
NON-OWNED AUTOS (Per accident)
>--
>-- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONL Y - EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
:=J OCCUR D CLAIMS MNJE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND IT~~n~WS I IOlH-
ER
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? ~~_ !J!SE.r...SE Ell, EMPLOYEE $
If yes, describe under EL. DISEASE - POLICY LIMIT $
SPECIAL PROVISIONS below
OTHER
A E&O Liability 0902MFAOOO080 02/05/09 02/05/10 Per Claim $2,000,000
Aggregate $4,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT f SPECIAL PROVISIONS
This Certificate of Insurance serves only as evidence of Professional (E &0)
/ General Liability coverage.
CERTIFICATE HOLDER
CANCELLATION
CIT32AS
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Ashland-Electric Dept
Attn: Scott Johnson
90 N. Mountain Ave.
Ashland OR 97520
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30
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
ACORD 25 (2001/08)
@ACORDCORPORATION 1988
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