HomeMy WebLinkAboutInsurance Certificate: Cascade Employers Association
Certificate of Insurance
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE IS NOT AN
INSURANCE POLICY AND DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED.
This is to Certify that
~ Libe~
~ Northwest.
CASCADE EMPLOYERS ASSOCIATION INC. OF MemberofLibertyMutualGroup
CASCADE EMPLOYERS PREFERRED RI SK GROUP Liberty Centre
4068 HUDSON AVE NE 650 NE Holladay Street
PO Box 4555
SALEM OR 97301- 514 2 Portland, OR 97208-4555
11.1..1...1..11.11......11.1.111..11.1..1..1.1.11..1..1..1..11
Tel: 5032395800
www.libertynorthwest.com
is, at the date of the certificate, insured by the Company under the policy(ies) listed below. The insurance afforded by the listed policy(ies)
is subject to all their terms, exclusions and conditions and is not altered by any requirement, term or condition of any contract or other
document with respect to which this certificate may be issued.
EXPIRATION
DATE
TYPE OF POLICY
POLICY NUMBER
LIMITS OF LIABILITY
r>;it WORKERS'
~ COMPENSATION
COVERAGE AFFORDED UNDER WC lAW OF
FOllOWING STATES
OR
COVERAGE AFFORDED UNDER WC lAW OF
FOllOWING STATES
4/01/2010 WC4-1 NC-O 16671
EMPLOYERS LIABILITY LIMITS
EMPLOYERS LIABILITY LIMITS
Each Accident
Disease - policy limit
Disease - each employee
$500.000
$500.000
$500.000
Each Accident
Disease - policy limit
Disease - each employee
MARITIME COVERAGE - FOllOWING STATES
LIMIT OF L1AB. - MARITIME COVERAGE
GENERAL LIABILITY
General Aggregate
D Commercial General
liability (Occurrence)
D Owner's and Contractors
Protective
Products Comp/Ops Aggregate
$
$
$
$
$
$
Personal & Advertising Injury
Each Occurrence
Fire Damage (Anyone fire)
Medical Expense (Anyone person)
AUTOMOBilE L1ABILlT't
D Any Auto
D All Owned Autos
o Scheduled Autos
D Hired Autos
D Non-owned Autos
o Garage Liability
LOCATION(S) OF OPERATIONS & JOB # (IF APPLICABLE)
CSl
Bodily Injury (Per Person)
Bodily Injury (Per Accident)
Property Damage
$
$
$
$
DESCRIPTION OF OPERATIONS
CANCELLA TION:
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING
COMPANY WILL ENDEAVOR TO MAIL ::\0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED BELOW, BUT
FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, OR
REPRESENTATIVES.
MAilED TO:
CITY OF ASHLAND
20 E MAIN ST
ASHLAND OR 97520-1814
11.1..1...1.1.1...1.111......111..1....11.1..1..1.111..11..111
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CERTIFA
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