HomeMy WebLinkAboutInsurance Certificate: Engineered Monitoring Solution
~
~R '" CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY)
OPID BW .
ENGIN-1 12/14/09
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
RIS Insurance Services HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
PO Box 1059 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Anacortes WA 98221
Phone: 360-293-2135 'Fax:360-293-2385 INSURERS AFFORDING COVERAGE NAIC#
INSURED . .. ,. INSURER A: Western National Assurance 24465
I
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, INSURER B: "" to' '.......:.
.-.- ~ .~. .. , ". E'.,-;';l..
, : ENGINEERED MONITORING SOLUTION INSURER c:
; (:';.-20345 SW PACIFIC HWY # 104 ; INSURER 0 I '~.." 1..' : _ 7,l'. ;.,
....-.........:- SHERWOOD..OR,97140 -- ...... .-- .-- :
INSURER E: -.. ~ '!.. -
. COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDtCATED. NOTWITHl;iTANDING
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
L TR NSR TYPE OF INSURANCE
GENERAL LIABILITY
I---
POLICY NUMBER
lfTLJ7~~J6~1 b~'r~~~~~~
LIMITS
COMMERCIAL GENERAL LIABILITY
I CLAIMS MADE D OCCUR
EACH OCCURRENCE S
I PREMISES (Ea occurence) S
MED EXP (Anyone person) S
PERSONAL & ADV INJURY S
GENERAl AGGREGATE .
PRODUCTS.COM~OPAGG S
GEN'L AGGREGATE LIMIT APPLIES PER:
Ii ,-,PRO.,-,
POLICY I I JECT I I LOC
~TOMOBrLE LIABILITY
ANY AUTO
CF300003086
12/03/09
12/03/10
COMBINED SINGLE LIMIT
(Eaaccident)
s 1,000,000
A
I---
I-- ALL OWNED AUTOS
f-- SCHEDULED AUTOS
X HIRED AUTOS
t . c=-
~.. ....' r ".' ~ NON~OWN~~A~TOS r.
': ."3. I~: ". _ ~ :- ,
--..1--- -..-.
BODilY INJURY
(Per person)
s
';1
BODilY INJURY
(Per Bccident) ,
s
PROPERTY DAMAGE
(peraccidenl)
$' ... . ~..~"._.'_..
GARAGE LIABILiTY'
R'A~Y'AUTO
. , EXCESS I UMBRELLA LIABILITY
o OCCUR D CLAIMS MADE
RDEDUCTIBlE
RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y I N
ANY PROPRIETOR/PARTNER/EXECUTIVD
OFFICERfMEM8ER EXCLUDED?
(M.nd..tof)l fn-NHj- .. . - I
II ye,. de$cribe under
SPECIAL PROVISIONS below
OTHER
...' ,~
.;)' ":.t.:-"
. ......;
...
. ",',
AUTO ONLY. EA ACCIDENT $
EACH OCCURRENCE
AGGREGATE
EAACC $!
AGG $
S
S
S
S
S
OTHER THAN
-AUTO ONLY:
- ---.-...,.. ---- -- - ~-" ~
,
IT~~/I,~:i's I IV.,,'
E.L. EACH ACCIDENT $
E.L. UISEASE - EA "EMPLOYEE $
E.l. DISEASE - POLICY LIMIT $
A Physical Damage CA300005750 12/03/09 12/03/10
Hired Auto
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
attn:KARI OLSON
541-488-5320
$500 DED
$ 50,000
Comp & Co11
Limit
CITY RECORDER
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITYAS1 DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
NonCE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO so SHALL
CITY OF ASHLAND IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
90 N MOUNTAIN AVE. REPRESENTATIVES.
ASHLAND OR 97520 AUT~ED REPRESENTATIVE
I //': F
ACORD 25 (2009/01)
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