HomeMy WebLinkAboutInsurance Certificate: Brotherton Pipeline
ACORD. CERTIFICATE OF LIABILITY INSURANCE OP ID ME I DATE (MM/DDfYYYY)
9BROTPI 06/08/09
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Hart Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P. O. Box 1240 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Grants Pass OR 97528
Phone: 541-479-5521 Fax:541-474-1890 INSURERS AFFORDING COVERAGE NAlC#
INSURED INSURER A: Travelers Indemnity Co. 10647
INSURER B: Travelers Property Casualty CQ 10647
Brotherton Pipeline ( Inc. INSURER c: SAIF CORP
Brotherton Corporat~on
11 South Fronta~e Road INSURER 0:
Gold Hill OR 97 25
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 OOCUMENTWITH 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.
LTR NSR TYPE OF INSURANCE POLICY NUMBER PD'l~~rJ~rJ6,w\E P8k~CEY/ij~b'bm~N LIMITS
~NERAL LIABILITY EACH OCCURRENCE $1,000,000
A X COMMERCIAL GENERAl LIABILITY DTC0526D9764 06/10/09 06/10/10 PREMISES 'tEa occurence\ $ 300,000
l CLAIMS MADE [!] OCCUR MED EXP (Anyone person) , 10,000
PERSONAL & />J)V INJURY '1,000,000
GENERAL AGGREGATE $ 2 / 000,000
i"l~ AGG~EnE LIMIT APnSIPER: PRODUCTS - COMP/OP AGG '2,000,000
X POLICY ~~8T LaC
~TOMOBIl.E LIABILITY COMBINED SINGLE LIMIT $ 1/000,000
B ~ ANY AUTO DT810526D9764 06/10/09 06/10/10 (Eaaccident)
- ALL OWNED AUTOS BODILY INJURY
,
- SCHEDULED AUTOS (Per person)
- HIRED AUTOS BODILY INJURY
,
- NON-OWNED AUTOS (Per accident)
- PROPERTY DAMAGE ,
(Peraccidenl)
RGELIABILITY AUTO ONLY - EA ACCIDENT ,
ANY AUTO OTHER THAN EAACC ,
AUTO ONLY: AGG ,
BESSfUMBRELLA LIABIl.1TY EACH OCCURRENCE $2/000,000
B X OCCUR D CLAIMS MADE DTSMCUP526D9764 06/10/09 06/10/10 AGGREGATE $ 2 / 000 / 000
,
~ DEDUCTIBLE ,
X RETENTION $10000 ,
WORKERS COMPENSATION AND X ITB'~lD~Ws I IOJ:
C EMPl.OYERS' LIABILITY 810614 10/01/08 10/01/09
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $1/000/000
OFFICER/MEMBER EXCLUDED? E.L. DISEASE _ EA EMPLOYEE $ 1,000,000
ll~es.describe under --- - - I-
S ECIAL PROVISIONS belaw E.L. DISEASE - POLICY LIMIT $1,000.000
OTHER
DESCRIPTION OF OPERATIONS Il.OCATlONS I VEHICLES {EXCl.USIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
CERTIFICATE HOLDER
CITYASH
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEl.LED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILl. ENDEAVOR TO MAlL 10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAIl.URE TO 00 SO SHAl.L
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINO UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPR SENTATIVE
RPORA TION 1988
City of Ashland
Public Works Dept.
20 E. Main Street
Ashland OR 97520
Michelle
ACORD 25 (2001/08)