HomeMy WebLinkAboutInsurance Certificate: Robert Lloyd Sheet Metal
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PRODUCER
CERTIFICATE OF LIABILITY INSURANCE
I DATE (MMJDDIYYYY)
OP ID ME
ROBER03 06/30}09
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFOROED BY THE POLICIES BELOW.
Western States - Albany
PO Box 865
Albany OR 97321
Phone: 541-926-4291 Fax:541-926-4298
INSURED
INSURERS AFFORDING COVERAGE
NAIC#
Robert Lloyd Sheet Metal Inc
PO Box 307
Independence OR 97351
,
COVERAGES
INSURER A:
INSURER 8:
INSURER C.
INSURER 0:
INSURER E:
Continental Western Ins Co.
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 1$ 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 J'Aq-Jf~MfJ6~1 b~~~TM~~b~~ LIMITS
GENERAL LIABILITY EACH OCCURRENCE '1,000,000
f-- ~~~~~s YE~;~~~nce)
A X COMMERCIAL GENERAL LIABILITY CWP2771935 07/01/09 07/01}10 $100,000
I CLAIMS MADE [!] OCCUR MED EXP (Anyone person) , 5,000
- PERSONAL & ADV INJURY '1,000,000
-' GENERAL AGGREGATE '2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $2,000,000'
Xl POLICY n 'lr8i n LOC Emp Ben. 1,000,000
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- '1,000,000
A ~ ANY AUTO CWP2771935 07/01}09 07/01/10 (Eaaccident)
- ALL OWNED AUTOS BODILY INJURY
(Per person) ,
SCHEDULED AUTOS
-
- HIRED AUTOS BODILY INJURY
$
NON-OWNED AUTOS (Per accident)
-
PROPERTY DAMAGE ,
(Per accident)
~R~GE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC ,
AUTO ONLY: AGG ,
D~SS I UMBRELLA LIABILITY EACH OCCURRENCE '3,000,000
A X OCCUR D CLAIMS MADE CU2771937 07/01/09 07/01/10 AGGREGATE $3,000,000
,
=1 ~EDUCT'BLE ,
RETENTION , $
WORKERS COMPENSATION I TORY LIMITS I xIU~~'
AND EMPLOYERS'lIABllITY YIN
A ANY PROPRIETORIPARTNERlEXECUTIVD CWP2771935 07}01/09 07}01}10 ~~CH ACCID~_ '1,000,000
OFFICERIMEMBER EXCLUDED?
(Mandatory in NH) WA STOP Gl\.P ONLY E.L. DISEASE. EA EMPLOYEE '1,000,000
If yes, describe under $1,000,000
SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Re: Ashland Fire and Rescue
CITY RECORDER
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRA TlON
KEITHWO DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ 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
Keith Woodley REPRESENTATIVES.
An'ZED REPRESENTATIVE
455 Siskiyou Blvd M~'fW~
Ashland OR 97520
ACORD 25 (2009/01)
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