HomeMy WebLinkAboutInsurance Certificate: Kenneth & Valerie Batten
~
~ '" CERTIFICATE OF LIABILITY INSURANCE OPID PGM I DATE (MM/DDIYYYY)
05/17/10
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BElWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMI"ut<TANT: If the certificate holder IS an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGA, 'UN ,<> ,Subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER NAME:
Protectors Insurance, LLC I r11gNJo Ext: I rffc, No)o
Pilot Rock Ins Agency LLC (CA)
PO Box 4669 I AOmOI\RESS:
Medford OR 97501 CUSTOMER 10 #: BATTKEl
Phone:54l-773-5358 Fax:54l-772-l906 INSURER(S) AFFORDING COVERAGE NAlC#
INSURED INSURER A : First National Insurance Co 24724
Kenneth & Valerie Batten INSURER B :
1070 Kristin Dr
Medford OR 97504 INSURER C :
INSURER 0 :
INSURER E :
INSURER F :
COVERAGES
CERTIFICATE tiUM8Eji:
REVISION NUMBER:
THIS IS TO CERTIFY THAT 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 INSURf.NCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. .
I'LTR TYPE OF INSURANCE ~~~ I~' POLICY NUMBER (~~M5~ (MMIDDIYYYY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
f--
COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $
I CLAIMS-MADE D OCCUR MED EXP (Anyone person) $
f-- PERSONAL & ADV INJURY $
f- GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $
h ,nPRO, n $
POLICY JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 300000
- (Ea accident)
A ANY AUTO P5438465 01/28/10 07/28/10 BODILY INJURY (Per person) $
-
ALL OWNED AUTOS BODILY INJURY (Per accident) $
-
- SCHEDULED AUTOS PROPERTY DAMAGE
HIRED AUTOS (Per accident) $
- $
NON-OWNED AUTOS r'l\\ -_._---~
- - '1 \\( ';-:"~ rn\ $
UMBRELLA LIAB H ~CCUR :U) - " ':1 I EACH OCCURRENCE $
- "
EXCESS LIAB CLAIMS-MADE :In,' I I AGGREGATE $
- DEDUCTIBLE MAY 2 0 200 ; i $
RETENTION $ , .J, $
WORKERS COMPENSATION L__~_ I TORY LIMITS I I Ol~ -
AND EMPLOYERS' LIABILITY VIN
ANY PROPRIETOR/PARTNER/EXECUTIVD , E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? IA I
(Mandatory in NH) -- E.L. DISEASE - EA EMPLOYEE $
g~sc:~f~i~8~ OnFdOPERATIONS below E.L. DISEASE - POLICY LIMIT $
A Safe co comp ded $500
coll ded $500
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 104 Additional Remar1l:s SChedUlebif more space is required)
2004 DODGE STRATUS SEDAN lB3EL 6XX4N2ll502, 2 07 Cadillac Escalade,
2006 Jeep Wrangler
CERTIFICATE HOLDER
CANCELLATION
0000000
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Ashland
20 E Main St
Ashland OR 97520
AUTHORIZED REPRESENTATIVE
ACORD 25 (2009/09)
TION. All rights reserved.