HomeMy WebLinkAboutInsurance Certificate: Pacific NW Drilling
ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDIYYVY)
~ 04/30/2009
PRODUCER (541) 68 7 -1117 FAX (541)342-8280 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Ward Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P D Box 10167 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Eugene, OR 97440
Rob Harvey INSURERS AFFORDING COVERAGE - NAIC#
INSYRED lBergeson-Boese-& Associ ates Inc INSURER A: Endurance AmericarFSpecialty Ins Co
DBA: Pacific Northwest Drilling INSURER B: N~tionwide Mutual Ins __ Corri'pany I - 23787 _" --.- ,
: : '329~6. R,!~~.r.ts. Court ,
, 1 INSURER c: SAIF I ..~. . '];' ,
,
i ICpb~rg "IOR, 97408 , i I
, INSURER D' -.... - ~ " -- .. -
__0. INSURER E' " .. .., i
, ~ : .(~.-'F ,O',/f,10"" I ,
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.
I T~~~I~JI~S I IOJ~-
EL. EACH ACCIDENT $ 1,000,000
EL DISEASE - EA EMPLOYEE $ 1 , 000 , 000
E.L. DISEASE - POLICY LIMIT $ 1,000,000
LIMIT: $1,000,000
LIMIT: $1,000,000
I~f~ N~'k~
POLICY NUMBER 6R}JC,~~~6g~
ECCI0I007042 04/30/2009
TYPE OF INSURANCE
~~~~crM~~b~~W~
04/30/2010
~NERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
I CLAIMS MADE 0 OCCUR
EACH OCCURRENCE
~~~~~~J9E~~~i~nrel
, MED EXP (MY one person)
.
.
.
PRODUCTS - COMP/OP AGG $
A
PERSONAL & ADV INJURY
~
~
~'L AGGRE~E LIMIT AP~S PER:
I POLICY I I ~~C?T I 1 LOC
~TOMOBILE LIABILITY
~ ANY AUTO
_ 'ALL OWNED'AUTOS
B _..... = ,'S'CHEDuLEDA."lrrOS' -... . --.
~ HI~~DAl{19S :', > ,'r.).'
~. \~:>N~~0.E~\~..UTOS-\~,;, 'I.t:
GENERAL AGGREGATE
ACP7551541172 04/30/2009
04/30/2010
COMBINED SINGLE LIMIT
(Eaaccident)
''-,.'.
BODILY INJURY- - .
(Per person)
- - BODILY INJURY-
(Peracddent)
I....
. ,. . -' ,
PROPERTY DAMAGE
(Per acCident) ..:
-
';'..;
','
.
~RAGE LIABILITY
-I ANY AUTO
AUTO ONLY - EA ACCIDENT
OTHER THAN
AUTO ONLY:
~ESS I UMBRELLA LIABILITY
----.J OCCUR D CLAIMS MADE
. I DEDUCTIBLE
---I RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y! N
ANY PROPRIETORIPARTNERlEXECUTlVED
C. OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
SPECIAL PROVISIONS below
OTHER
POLLUTION LIAB
A ROFESSIONAL LIA8
EACH OCCURRENCE
AGGREGATE
473858 01/01/2009
01/01/2010
ECCI0I007042 04/30/2009
ECCI0I007042 04/30/2009
04/30/2010
04/30/2010
LIMITS
.
.
1,000,000
50,000
5,000
1,000,000
2,000,000
2,000 000
.
.1,000,000
r-r-
-
. ,
-
.
.
EAACC $
.
$
$
$
$
AGG
$
I..-~ESCRIPTlON OF OPERATIONS { LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT ( SPECIAL PROVISIONS
HE CITY OF ASHLAND, ITS OFFICERS, EMPLOYEES ANO AGENTS ARE ADDED AS ADDITIONAL INSUREDS IF REQUIRED BY
WRITTEN CONTRACT
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
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
CITY DF ASHLAND IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
20 E MAIN STREET REPRESENTATNES.
ASHLAND, OR 97520 AUTHORIZED REPRESENTATIVE 1,(;~j:d/'rU2\
, Rob Harvev/CARSON
ACORD 25 (2009/01)
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