HomeMy WebLinkAboutInsurance Certificate: Newco dba Cascade Columbia
ClTY RECORDER
A CORD_ CERTIFICA TE OF LIABILITY INSURANCE I DATE (MMIDDfYYYY)
10/30/2009
PRODUCER (206) 838-9077 THIS CERTIFICATE IS ISSUEO AS A MATTER OF INFORMATION
DML Insurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLOER. THIS CERTIFICATE DOES NOT AMENO, EXTENO OR
4005 20th Ave W Ste 132 ALTER THE COVERAGE AFFOROEO BY THE POLICIES BELOW.
Seattle WA 98199- INSURERS AFFOROING COVERAGE NAIC#
INSURED INSURER A: American Intll Special tv
Newco, Inc. dba Cascade Columbia Distribution; INSURER B: Commerce and Industrv
at al INSURERc:American Int'l Specialty
6900 Fox Ave S INSURER D
Seattle WA 98108- 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 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.
INSR ADD'L TYPE OF INSURANCE POLICY NUMBER PJl,N~~~~~8~E Pg~!fJI~~b~~N
lTR INSRO LIMITS
A ~NERAL LIABILITY EG2674220 10/31/2009 10/31/2010 EACH OCCURRENCE . 1,000,000
X COMMERCIAL GENERAL LIABILITY ~~~~~~J?E~~~~enca\ $ 100,000
-. -j -.J-CL:AiMSMADE W.OCCUR / / / / MED EX? AnI! one person) . 25,600
Pollution Liability PERSONAL & ADV INJURY . 1,000,000
X Vendors Liability / / / / GENERAL AGGREGATE . 2,000,000
~'~ AGG:Er~~rllMIT ArilES PER: PRODUCTS. COMPfOP AGG $ 2,000,000
POLICY ~~8i X lOC / / / /
B ~TOMOBILE LIABIUTY CA7665964 10/31/2009 10/31/2010 COMBINED SINGLE LIMIT
(Eaaccident) . 1,000,000
~ Am AUTO
- All OV\tJED AUTOS / / / / BODilY INJURY
(Perper$on) .
- SCHEDULED AUTOS
- HIRED AUTOS / / / / BODilY INJURY
(Per accident) .
NON-OV\tJED AUTOS
- / / / /
- PROPERTY DAMAGE
(Per accident) .
~RAGE UABIUTY AlfTOONlY. EAACCIDENT $
ANY AUTO / / / / OTHER THAN EAACC $
AUTO ONLY: AGG .
C ~ESS/UMBRELLA LIABILITY EAU2679B23 10/31/2009 10/31/2010 EACH OCCURRENCE $ 15,000,000
X OCCUR D CLAIMS MADE AGGREGATE $ 15,000,000
$
~ DEDUCTIBLE / / / / $.
X RETENTION S 10,000 .
WORKERS COMPENSATION AND / / / / I T~~ItJNs I IOTH-
EMPLOYERS' LIABILITY 'R
ANY PROPRIETORIPARTNERlEXECUTlVE E.l. EACH ACCIDENT .
" .OFFIr,"'R/M~MP:F.R F.XCI.lJDIED? . - I / - ./ '/ E.l. DISEASE. EA EMPLOYEE $ ,
If yes, describe under
SPECIAL PROVISIONS below E.l. DISEASE - POLICY LIMIT $
B OTHER Auto Physical Damage CA7665964 10/31/2009 10/31/2010 Comprehensive Oed 1,000
/ / / / Collision Deductible 1,000
/ / / /
DESCRlPTlON OF OPERATIONSfLOCA TlONSNEHICLESlEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLOER
(541) 488-5354
Kari Olson
CANCELLATION
(541)
- Purchasing
488-5320
ELECTRONIC LASER FORMS, INC. - (600)327..0545
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LlABIL.ITY OF ANY KIND UPON THE
INSURER ITS AGENTS OR REPRESENTATIVES.
AUTHORlZEDREPRESENTATlVEf.~':'.'."'-""'~' "... .-.... . - ::
~~- .
1 .. .
@ACORD CORPORATION 1988
Page 1 012
City of Ashland
90 N Mountain Avenue
Ashland
ACORD 25 (2001/08)
~Thl-INS025(0108),05
OR
97520-