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Home My WebLink AboutInsurance Certificate: Cascade Airport Shuttle ~ "--.-.-"--.-----.----~-~,--_. ~__ ____N__ ________ ______ _______ ___ _~_______ _~__ ________ .o' ACORD. CERTIFICATE OF LIABILITY INSURANCE OPID MP I DAlE (MIIIDDIYYYYI CASC23C 01/28/09 PRODUCER THIS CERTIFiCATE is ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIACATE United Risk Solutions, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR PO Box 936 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. "- 'Iedford OR 97501-0067 2hone:541-245-1111 Fax: 541-245-1112 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:. w..urn National q.-utance CO INSURER B: Brookwood Insurance Co. Cascade Ai~ort Shuttle INSURER c: Ashland Shu tIe, LLC 3295 H'!Y 66 INSURER 0: Ashland OR 97S20 INSURER E: COVERAGES '- THE POUClES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOO INDICATED. NOTWlTHST ANOING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT 'MTH RESPECT TO INHICH 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 ~S. AGGREGATE UMITS SHOIM< MAY HAVE BEEN REDUCED BY PAlO ClAtMS. DA1EIMMto~ DATEM~ L TR TYPE OF INSURANCE POUey NUMBER UNITS ~NERAL LIABIUTY EACH OCCURRENCE '1,000,000 A X COMMERCIAlGENERAlLIABlUTY CPPOO1477102 02/08/09 02/08/10 PREMISES W'a oco./Ilmce) . 100,000.. I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) . 5,000 PERSONAL & ADV INJURY . 1, 000 ,000 GENERAL AGGREGATE .2,000,000 ~~ AGGREGATE UMIT APnS PER PRODUCTS. COMPfOP AGG '2,000,000 I r-'f PRO- POLICY JECT lOC ~TOM08ILE UABlUTY COMBINED SINGLE LIMIT . 1,000,000 B X ANY AUTO ORAOO1618 02/08/09 02/08/10 (Eaacddent) - - All OINNED AUTOS BODILY INJURY . ~ SCHEDULED AUTOS (perP'"Ofl) - HIRED AUTOS BOOll Y INJURY . - NON-O'NNED AUTOS {Peraccidenll - PROPERTY DAMAGE . (Peracdclent) - RAMG. UABR.lTY AUTO ONLY - EA ACCIDENT . ANY AlITO OTHER THAN EA Ace . AUTO ONLY: AGO . EXCESSJUMBREll.A LIABSLITY EACH OCCURRENCE . (j'OCCUR 0 ClAIMS MADE "'- AGGREGATE . . ~ ~DUCT1BLE . RETENTION . . WORKERS COMPENSATION AND I TORY LlMrTS I I'.R EMPLOYERS' UABlUTY ANY PROPRIETORIPARTNERlEXECUTIVE E.L. EACH ACCIDENT . OFFICERlMEMBER EXClUDED? E.L. DISEASE - EA EMPLOYEf It yes. describo Under . SPECiAl PROVISIONS below E.L. DISEASE - POllCY LIMIT . OTHER B AUTO PHYSICAL ORAOO1618 02/08/09 02/08/10 $500 DED COMP DAMAGE / ACV $500 DED COLLISION DESCFUPnON OF OPERAOONS J LOCATlONS / VEHIClE:S / EXClUSIONS ADDED BY ENDORSEMENT J SPECIAl. PROVISIONS 2000 Ford 7-Pass Van, S#2FMDA5147YBA55581 2004 Toyota Camry, S#4T1BE32K24U919177 2007 Toyota Sienna Van, S#5TOZK32C17S048388 $i p:...S'S..~ CERTIFICATE HOLDER IS ADDITIONAL INSURED CERTIFICATE HOLDER City of Ashland Its Officers, Employees and Agents 20 E Main St Ashland OR 97520 CANCELLATION ASHAS 0 1 SHOULD ANY OF THE ABOVE DESCRlBED POUaEs BE CANCEllED BEFORe ntE EXPIRATION DATE ntEREOF, THE ISSUING INSURER WJLL ENDEAVOR TO I4AfL ~ DAYS WRITTEN NOTICE TO ntE CERTIRCATE HOLDER NAMED TO TKE LEFT, BUT FAILURE TO DO SO SHAll IMPOSE NO OBUGATJON OR. UABIUTY OF ANY KIND UPON ntE INSURER,. ITS AGENTS OR. REPRESENTATIVES, ~,..~ @ACORDCORPORATION1988 \''- ACORD 25 (2001/08) Western National Assurance I.;ompany 97G6 4th Avenue NE, Ste 200 Seattle, WA 98115-2162 www.wnins.com \y WESTERN NATIONAL h.su..lu'oc.. n",rrlarlOlldtip<>=lp<1nv COMMERCIAL GENERAL LIABILITY COVERAGE PART ,...."". G ) # 0000232570 Po"..y # CPP 0014771 02 Policy Period: From FEBRUARY 8, 2009 To FEBRUARY 8, 2010 12:01 A.M. standard time at the Named Insured's mailing address. Transaction RENEWAL DECLARATION Insured Name end Address CASCADE AIRPORT SHUTTLE 3295 HWY 66 ASHLAND OR 97520 Agent UNITED RISK SOLUTIONS INC PO BOX 936 MEDFORD, OR 97501 02032 Telephone: 541-245-1111 Business Description AIRPORT SHUTTLE SERVICE Type of Business LIMITED LIABILITY CO Audit Period ANNUAL Billing Type DIRECT IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO All THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. '--" LIMITS OF INSURANCE General Aggregate Limit (Other than Products-Completed Operations) Products - Completed Operations Aggregate limit Each Occurrence Limit Person'al and Advertising Injury Limit, anyone person or organization Medical Expense Limit, anyone person Damage to Premises Rented to you, anyone premises $ 2,000,000 $ 2,000,000 $ 1,000,000 $ 1,000,000 $ 5,000 $ 100,000 LOCATIONS OF ALL PREMISES YOU OWN, RENT OR OCCUPY Refer to attached schedule. CLASSIFICATIONS Refer to attached schedule. PREMIUM FOR THIS COVERAGE PART $ 250.00 DISCLOSURE OF PREMIUM: The portion of your annual premium attributable to coverage for certified acts of terrorism is $ 1.00 "'-"'. Forms ,and Endorsements Applicable to this Policy See Forms and Endorsements Schedule Issued Date: 01/13/2009 WN Gl 06 07 07 INSURED COPY Page 1 of 5 " , Dave's Import Service Inc. 1903 Sky park Dr. #105 Medford, OR. 97504 Phone - 541-776-3283 Fax - 541-772-4889 Quality, Personalized Service INVOICE I 13468 I Org, Est # 032655 INVOICE Cascade Shuttle Nancy Print Date: 04/30/2009 2000 Ford - Windstar LX 3.8L, V6, VIN (4) Lic #: XLB881 Odometer In: 260217 Un~#: Vin #: 2FMDA5147YBA55581 Hat#: Extended Labor Description I PERFORM SAFETY INSPECTION BRAKES GOOD,ALL LIGHTS WORKING, fRONT TIRES DOWN TO WEAR BARS. REAR TIRES CUPPED,NOlSY UREAR WHEEL BEARING. SAFETY INPECTION INC: 21 PTINSPECTlON. CHECK ALL FLUIDS, HOSES AND BELTS, AND WIPERS. PRESSURE TEST COOLING SYSTEM. CHECK CHARGING SYSTEM, BATTERY AND LIGHTS. INPECT BRAKES AND TIRES. Office 541-488-1998 Cust 10 : 2803 Part Description / Number Ref#: Qty Sale I Technicians; 006dl, ] Org. Estimate 539.50 I Revisions SO.OO Current Estimate S. 39~~ Additional Cost Revised Estimate Labor: Parts: Sublet: [ Payments - J Sub: Tax: Total: Bar Due: Extended 39.50 NiC 39,50 0,00 0.00 39,50 0.00 39,50 1:39,50 I I hereby authorize the above repair work to be done along with the necessat)" material and hereby grant you and/or your employees pernission to operate the car or truck herein described on street, highways or elsewhere for the purpose to testing and/or inspectioo. An express mechanic's lien is hereby acknowledged on above car or truck to secure the amount of repairs thereto. Warranty on parts limited to manufacturers liability. Workmanship is for one year. SIGNA TURE........................................ ....................,.................................... Date......................................... Time............,......,..... Vritt&rl By: F.. David Page 1 of 1 01.17.07 Copyright Milc:hell1 Invoicl ..~ . Dave's Import Service Inc. 1903 Skypark Dr. #105 Medford, OR. 97504 Phone - 541-776-3283 Fax - 541-772-4889 Quality, Personalized Service INVOICE I 13466 I Org. Est. # 032650 INVOICE Cascade Shuttle Nancy Office 541-488-1998 Cust 10 : 2803 Part Description / Number Ref#: Qty Sale Extended 2004 Toyota - Camry LE 2.4L, In-Line4, VIN (E) Lic #: 236CBQ Unit#: Vin #: 4T1BE32K24U919177 Hat#: Labor Description --._--.._-~~_. -~---~ PERFORM SAFETY INSPECTION BRAKES GOOD,ALL LIGHTS WORKING.ALL IN WORKING ORDER SAFETY 1NPECTION JNC: 21 PTJNSPECT10N. CHECK ALL FLUIDS, HOSES AND BELTS, AND WIPERS. PRESSURE TEST COOLING SYSTEM. CHECK CHARGING SYSTEM. BATfERY AND LIGHTS. 1NPECT BRAKES AND TIRES. Print Date: 04/3012009 Odometer In: 161546 -, Extended 39.50 N/C ;f ~ " [ Technicians; 006<11, J Org. Estimate SJ9.50 ReviSions SO.OO Current E'5timate S 39.50 Additional Cost Revised Estimate Labor: Parts: Sublet: 39.50 0.00 0.00 .. ., I; , ~ il " .. -.... - -- [ Payments - ] Sub: Tax: Total: Bal Due: 39.50 0.00 39.50 $39.50 I horeby authorize the above repair work to be done along with the necessary material and hereby grant you and/or your employees pel1nission to operate the car or truck herein described on weet, highways or elsewhere for the purpose to testing and/or inspection. An express mechanic's lien is hereby acknowledged on above car or trud" to secure tlle amount of repairs thereto. Wan'anty on parts limited to manufacturers liability. Workmanship is for one year. SIGNA TURE...........................................................................................,..... Date......................................... Time......................... 'fittE"-, Ay: F., Dalljd Page 1 of 1 OU7.07 Copytighl: MitcheJl1 lnvoic;