HomeMy WebLinkAboutInsurance Certificate: Welburn Electric (2)
~
~R '" CERTIFICATE OF LIABILITY INSURANCE DATE (MMfDDIYYYY)
OPID KIY I 12/28/09
WELBU-1
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Protectors Insurance, LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Pilot Rock Ins Agency LLC (CA) HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
PO Box 4669 ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW.
Medford OR 97501
Phone: 541-773-5358 Fax:541-772-1906 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A North Pacific
INSURER B
Walburn Electric Inc INSURER c:
PO Box 329 INSURER 0
Phoenix OR 97535
I 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 IS SUBJECT TO ALL THE TERMS, EXCLUSIONS ANO CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
LTR NSR TYPE OF INSURANCE POLICY NUMBER 6~TLJ~~~IODIYYYY DATE'"'''MMIDDIYYYY LIMITS
GENERAL LIABILITY EACH OCCURRENCE '1,000.000
-
A X COMMERCIAL GENERAL LIABILITY Cl7127353 12/23/09 12/23/10 PREMISES (Ea occurencel .100,000
1 CLAIMS MADE ~ OCCUR MED EXP (Anyone person) .5,000
PERSONAL &ADV INJURY .1.000.000
-
- GENERAL AGGREGATE .2,000,000
il'l AGG~Eft LIMIT APAS PER PRODUCTS - COMPIOP AGG .2,000,000
X POLICY j~c?T LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- .1,000,000
A ~ ANY AUTO Cl7127353 12/23/09 12/23/10 (Eaaccident)
- ALL OWNED AUTOS BODILY INJURY
(Per person) .
- SCHEDULED AUTOS
HIRED AUTOS BODILY INJURY
- .
NON-OWNED AUTOS (Per accident)
-
- PROPERTY DAMAGE .
(Per accident)
GARAGE LIABiliTY AUTO ONLY - EA ACCIDENT .
=i ANY AUTO OTHER THAN EA ACC .
AUTO ONLY: AGG .
:JESS I UMBRELLA LIABILITY EACH OCCURRENCE .
OCCUR D CLAIMS MADE AGGREGATE .
.
=i DEDUCTIBLE .
RETENTION . .
WORKERS COMPENSATION ITtJ~/~I~\f's I IU~,\'-
AND EMPLOYERS' LIABILITY Y'N
ANY PROPRIETORJPARTNERlEXECUTND EL. EACH ACCIDENT .
OFFICERlMEMBER EXCLUDED?
(Mandatory in NH) E.L. DISEASE EA EMPLOYEE .
~~Etl~S~~~v~S1~~s below E.L. DISEASE - POLICY LIMIT .
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT f SPECIAL PROVISIONS
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITYAS2 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
City of Ashland REPRESENTATIVES.
20 E Main Str
Ashland OR 97520 AUTHORIZED REPRESENTATIVE
R. Joe Hubbard
,
ACORD 25 (2009/01)
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