HomeMy WebLinkAboutInsurance Certificate: Peck Smiley Ettlin Architects
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f~CORD CERTIFICATE OF LIABILITY INSURANCE "OPID KI I DATE (MMJDDNYYY)
'I' ... PECKS-l 04/08/10
PRCgUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Ful1erton__& C~!l\pany ,... HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR .,
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P. O. Box 29018 ALTER THE COVERAGE AFFORDED BY,THE POLICIES BELOW. ..,
Portland OR 97296-'9018 .,
, ' INSURERS AFFORDING COVERAGE ">/'/,(t': i'
;Phone; 50~,u.2?4-.~?,g, Fax:503-274-6524 . - . NAIC#,
:INSUREO i> , INSURER A: Hartford Casual ty;"l ., I, 29424
, ' ,l~:U::"::i I
1 . 1 The Employer. Fire 'Insurance _206,48. ,_,
! r.:,.:HGPllfED ';.IUOP INSURER B: ',- j
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, ! j --~eck"'l'Siid'ley Ettlinl Architects INSURER C SAIF Corporation-'J,' I..
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I , v4412.SW Corbett Avenue~ INSURER 0: New Hampshire Ins. Co.
',Portland OR 97239-4207...
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 AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
~~Rd TYPE OF INSURANCE POLICY NUMBER
~NERAL LIABILITY
A X X COMMERCIAL GENERAL LIABILITY 52SBAUL7992
I CLAIMS MADE [!] OCCUR
~';!~JMMJDDIYYI- PMkh MMJDD1YYIN
EACH OCCURRENCE
04/01/10
04/01/11
PREMISES (Ea occurence)
MED EXP (Anyone person)
GEN'L AGGREGATE LIMIT APPLIES PER:
I POLICY n ~f8i n LOC
~T~~~BILE.L1ABILlTY
X ANY AUTO,.
= .. .
_)ALL:'OWNEDAUTOS-...,._ - ~ ~. _......_
; I - SCHEDULED AUTOS
1 '~~.:r:.! ~~_.~ HIRED_ AUTO_~___ ___ _ ___, ..___ _. ._~ _
I to ~\ ::it: I ;i'" ..~ON..'O_WNEO. A.,__U.,TO, S -~ --
.1.1". ,-- _ I.~;>'.':~')C:"'.S,\\"~2:'
I ~.C';. :..:T1. :1"(\ f'''''' ..... : _ ;.,
: ,.....1) :,) - .-
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
B
FFIE06005
,05/09/09
COMBINED SINGLE LIMIT
05/09/10.. (Eaaccidenl)
._. "'h
BODILY INJURY--
(Per person)
~:~.;~~..~. :.
"..,.].
'.1-.-....
LIMITS
'2000000
. 300000
. 10000
. 2000000
. 4000000
. 4000000
. 1000000
1
.i
_.L':~."""k-- '" _
. .'" '. ~":::.\
. '.~ .BODIL Y,INJURY
'- '(~raccide~I)_
__ - _. .!, ..:. [..It ; .~~
'.... "<;!.
.... ..'.
-- -. _.....-
I: .:;:r;
i :.,. t~
>:..: ..:lh\~.~
PROPERTY DAMAGE
(Peraccide~l)
C
GARAGE LIABILITY
=1 ANY AUTO
'\,. EXCESS/UMBRELLA LIABILITY
::lOCCUR ---EJ CLAIMS' MADE
I DEDUCTIBLE
,_~.RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERlMEMBER EXCLUDED?
~~~~I~ts~~~v~s1~~s below
OTHER
978205
AUTO ONLY - EA ACCIDENT
OTHER THAN
_A~TO ONLY:
',.' 1.. _
EACH OCCURRENCE
,AGGREGATE
-~---~..- -,- --.-- - -_. - ,- --
09/01/09
09/01/10
x I TORY "LIMiTS I IV d:\"
E.L EACH ACCIDENT
EA ACC
AGG
.
,- .
.
.
.
.
. .
.
.
.
$
E.L. DISEASE. EA EMPLOYEE $ 500000
E.L.DISEASE-POLlCYLlMIT $ 500000
$ 500000
D Errors & Omissions
12/19/09
Ea Claim
Aggregate
12/19/10
4392598901
$10,000 Deductible
DESCRIPTION OF OPERATIONS' LOCATIONS 'VEHICLES' EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
RE: All Operations
Certificate Holder is considered as additional insured with regard to
operations of the named insured in accordance with the policy terms,
conditions and exclusions.
CERTIFICATE HOLDER
CANCELLATION
1000000
1000000
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
City NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
of Ashland IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINO UPON THE INSURER,ITS AGENTS OR
90 North Mountain Ave
Ashland OR 97520 REPRESENTATIVES.
~~~J~\Jo--\.. .
ACORD 25 (2001/08)
@ ACORD CORPOR.~TION 1988
,
,
.
POUCY NUMBER: 52 SBA UL7992
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THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - PERSON-ORGANIZATION
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CITY OF ASHLAND, IT'S OFFICERS, EMPLOYEES, AND AGENTS
20 EAST MAIN STREET
ASHLAND, OR 97520
::: CITY OF, PORTLAND
::: 1120 SW 5TH AVE, ROOM #1204
~ PORTLAND, OR 97204-1985.
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Fonn IH 12001185TSEQ. NO. 002
PIoc:esa Date: 02/02/10
PrInted In U.s.A. Page 001
Expiration Date: 04/01/11
INSURED COPY
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