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ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDIYYYY)
TM 08/03/2009
PRODUCER Phone: (360) 598-3700 Fax: (360) 598-3703 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
MICHAEL J, HALL & COMPANY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HALL & COMPANY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
19660 10TH AVENUE N.E. AL fER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
POULSBO WA 98370
INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Travelers Casualty and Surety Co of America 31194
MARQUESS & ASSOCIATES INC INSURER 8: The Travelers Indemnity Company 25658
'P.O. BOX 490 INSURER C: Travelers Insurance Company 39357
MEDFORD OR 97501
INSURER 0:
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.
INsR ADO TYPE OF INSURANCE POLICY NUMBER Pg~~~~=g~E P~~i:,~':'~~N LIMITS
"R INsR
GENERAL LIABILITY 6806146N63A OS/29/09 OS/29/10 EACH OCCURRENCE . 1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED . 300,000
PREMISES (Ea oecurence)
I CLAIMS MADE [!] OCCUR - ME:U. EXP (Anyone person) . S,OOO
B ~ XCU, BFPD, OCP PERSONAL & ADV INJURY . 1,000,000
GENERAL AGGREGATE . 2,000.000
-
nLI AGGREffi LIMIT APPn:ER: PRODUCTS-COMP/OP AGG. . 2,000,000
PRO-
POLICY X JECT LOC
AUTOMOBILE LIABILITY BA6148N401 OS/29/09 OS/29/10 COMBINED SINGLE LIMIT
- (Eaaccident) . 1,000,000
~ ANY AUTO
X ALL OWNED AUTOS BODILY INJURY
c-- (Per person) .
SCHEDULED AUTOS
B f---
HIRED AUTOS BODtL Y INJURY
- .
NON-OWNED AUTOS (Per accident)
-
- PROPERTY DAMAGE .
(Peraccidenl)
GARAGE LIABILITY AUTO ONLY. EA ACCIDENT .
~ ANY AUTO OTHER THAN EAACC .
AUTO ONLY; AGG .
~E~S I UMBRELLA LIABILITY CUP3196T698 OS/29/09 OS/29/10 EACH OCCURRENCE . 5,000,000
OCCUR D CLAIMS MADE AGGREGATE . 5,000,000
C .
~ ,DEDUCTIBLE .
RETENTION $ 10,000 .
WCP.KERS CC:"PE"lSATION AND - I ~R~T~~S I I OTHER
EMPLOYERS' LIABILITY .. -
E.L. EACH ACCIDENT ,
ANY PROPRIETORIPARTNERJEXECUTlVE
OFFICERlMEMBER EXCLUDED? E.L. DlSEASE-EA EMPLOYEE ,
lfyel,delC'ribtlunder E.L. DISEASE-POLICY LIMIT .
SPECIAL PROVISIONS below
OTHER: 105320158 07126/09 07/26/10 $1,000,000 Per Claim
A Professional liability $1,000,000 Aggregate
Claims Made Form
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
Street Improvement Project #2005-34
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of Ashland EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS
WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE
20 E. Main Street TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER.
Ashland, OR 97520 ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE ~hleiHul~
Attention:
ACORD 25 (2001/08)
Certificate #
100308
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@ACORDCORPORATION 1988