HomeMy WebLinkAboutInsurance Certificate: Pacific Paving - Workers Comp
ACORD. CERTIFICATE OF LIABILITY INSURANCE OP 10 RZ I o.o.TE[WWIOONYY\')
PACIOSW 09/21/09
~~, THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
KPD Insurance, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
PO Box 784 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Springfield OR 97477
Phone: 541-741-0550 Fax: 541-741-1674 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER'" SArF Corporation - Salem 36196
"~,
Pacific Paving, Inc. ~,
PO Box 2370 _~o
White City OR 97503
~~,
COVERAGES
T>lEPaJClESlJFlNSURANCELlSlEDBELr.:1NHAVEBEENISSUEDTOTHElNSLREDNAMEDABrNEfORnEPOUCYF'ERIOOINOlCAlED.NOTWITHST"NtllNG
"'NYREClUlFlEMENT,TER~ORCGlomONOFAN'fCONTRAI;:TORlJTH!ORDOClJMONTWITl-IRlOSPECTTO""iIOjT1iISCERT1FICATEw..yaElSSUEDOR
WlVPEFlTAlN,THEINSuFto.NCEAFFCRDEDBYTHEPOLICIESDESCR,BEDHEREiNISSUBJECTTOAl..L1HETERMS.EXo..USIONSAN'OCO/'VITlONSDFSUCI-l
POl.ICIES.AGGREGO.TELlMITSSH~MAYHAVEBEENFlEDUCEDBYP""DCLAIMS
"M 0" ':~~~:~ ~';;~':~N
m ,~ TYPE OF INSURAHCE POlICYI<<JMBER ~I"'TB
~ERALllABlUlY EAOiOCOJRRENCE ,
DAMAGETORENTED
- ~(RClAlGENERALlIABIUTY PREMISES IE.o ooalrwoot) ,
CLAIMSw.DE D<lCCU'l lolEOEXP(A".,."""-",,,) ,
, PERSOOAl.&WJItVJRY ,
GENEIW.AGGREGAlE ,
~:GGREGATEFi~:PER n f'Ra'lUCTS_COI.I"IOI'.o.= ,
PaJCY JEel ~oc
~l1fOMooa..EUABn..1TT COMBINEDSINGLELlMrT ,
MNAUTO (E.oaccidoof1ll
-
- ALLO~EDAUTOS BOOILYINJLlil.Y
,
SCI-IEDULEOAUTOS (Perporoan)
-
- HIRED AUTOS BOOILYINJURY
,
NON~DAUTOS (Per_,)
-
I'ROPERTYo.oJ.IAGE ,
(f'..--..)
~~~.= AUTOONLY-EAACQDEN'T ,
ANY AUTO OTHERlliAN EAACC ,
AUTO ONLY; '00 ,
SSllIUlIBIlfOLLALlABlUTY . EACliOCOJAAENCE ,
OCCUR DUA'MSMAIlE AGGREGATE ,
,
~:""'"':' ,
~~ , ,
WOIlKERSCOMI'ENSATJOHANl XIT~~~ I 10;
EMl'LOYl'RS'UAlllUTY 812919 10/01/09 10/01/10
A AHYPRCI'RlETCRlPARTNERlEXEo..mllE E L EA01 AOXEN'T $ 500,000
OFFlCEM.<E...CllI:Jl;ExCuDED"' EL.DlSEASE-EAEMPLOYEE , 500 000
~:-~=OVl":'ONS,>::.>...., . - . ._- - ---- . . -
E.L.OlSEAsE_POLICYLMIT , 500 000
OlliER "
:
.'
OEi!lCAIPTJOHOFOPERATJOHlIILOCATIOHSIVF.:HICLElIIEllCLlJlI.IONlIAODEOBYENOORlIElIENTISPEClALPROVl8lONlI
RE, All Operat.ions
<'""TV RECORDER
. ,
CERTIFICATE HOLDER
CANCELLATION
CITAS02
SHOuLDAKYOFTllE ABOVE DE!lCRIBED POLICIESBE c.o.NCHI.ED BEFORE TllEEllI'lRATlON
C.i ty of Ashland
Finance Department
Attn: KariAnn Olson
90 N Mountain Ave.
Ashland OR 97520
OATETHEREOF.TllEISSllINOIHSuRERWlUENOEA'<<lRTO.....IL
~OAYSWRITTEN
NOllCE TO THE CERllFICATE HOLDERlfAlIED TO THE LEFT. BlITFAILlIRE TO DO 80 SHAU
11IPOSE NOOBLlGATJOH ORUABlUTYOF AKY KlNDlIPON THE INSURER. ITS AGENTSOR
ACORD 25 (2001108)
@ACORD CORPORATION 1988