HomeMy WebLinkAboutInsurance Certificate: Larson's Superstore
ACORD. CERTIFICATE OF LIABILITY INSURANCE OP 10 KeF I OAn;(Il:IAIDlI1YYYYJ
LARS02W 06/14/10
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER DF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
United Risk Solutions, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
PO Box 936 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Medford OR 97501-0067
Phone: 541-245-1111 Fax; 541-245-1112 INSURERS AFFORDING COVERAGE NAIC#
..WRf;D . BAIF Corporation
INSURER'"
Larson's Superstore (dba) INSURERS
Larson~s Flooring & More
Bruce Larson INSURERC
213 S Fir st INSURER 0
Medford OR 97501
INSlJRERE
COVERAGES
THEPOUClESOFINSUR,t.NCEUSTEOBELOW....veBEENISSUEDTOTHEINSUAED~ABOVEFORTHEPQUCYPERlOIlN)ICATEO.NOTWITHST...-:>lNG
~REauIREI.ENT.TEFlMORCONDITIONOFANYCONTAACTOROTHERDOCUMENTWlTHRESPEcrTOWl1ICHTHlSca1TIFlCJ\TEW.YBEISSUEDOR
MAYPERTAIN,THEINSlJRANCEAFFOROEDBYTHEPOLlClESDESCFUBEDHEREINISSUBJECTTOALLTHETERMS,EXCl-USIONSANDCONOrTIONSOFSUCH
POlICIES.AGGREGATElIMITSSHOWNIMVHAVE:BEENREDUCEDBYPAlDCLAIMS
oM ":;:; POUCYEFFECTlVE POUCYEXl'lRATlON
em TYPEOF..lllJRANCE POUCYJaJIIBER OATE(1OMlIl/VY) DATE(MaWD/YV} LIMITS
BENERALUA8lUTY EACl"OCCI.IRRENa: .
- O.........GETORENTED
COI&ERClAL GENERAl. UA8lUTY PREMISES (Eo "",.........) .
ICLA,I,lSMAOE o OCCUR !.EO ExPiAnyanoporlOn) .
PERSOOAl&ADVINJlJRY .
GENERAl-AGGREGATE .
GEN\.AGGREGJlTEUMlTAf'F'lESPER PRODI.ICTS-COI.II'tOPAGG .
!PQ.ICY n::g; .nlOC
AU1OlllOllILElIABILJfY n WI I? -7:; Y COMllINED SINGLE LIMI1
- l]{~{~i=~ .
ANYAUlO iEooa;idont)
- . \ - -'-'1\ I
- ALLO'M<EDAUTOS llOO,"YIN..uRY
.
SCHEOulHJAUTOS (P<<po=n)
- ['" ~I
HlREOAU1OS JUN 1 2010
- il l\: BOOILYt>I.AJRY .
NOO.OWNEDAUTOS (P.._tl
-
I ,I I PROPERTY DAMAGE
I (Por_1 .
GARAGEUABILflY I I AUTOGILY.EAACClDENl .
=i^~"" OTHER1HAN EAACC .
AUTO ONLY ^" .
:5::~~D "^"'~ EACHOCClJRRENCE .
AGGREGATE .
.
=i:"ocr"" .
RETEN1ION . .
WORKERS COMPENSAllOH AND 11 WCS1A1U. I IOTH-
X 1QRYUurrS "
EMPLOYERS'LLl8ll.ITY
A ANVPROPRIETORIPNIlNERlEXECUTfIIE 955014 07/01/10 07/01/11 ELUlCHACClCENT $ 500,000
OFF~RJI.lEMBERE.>\CLUOED? E.LDISEASE.EAEMf\.~ $ 500,000
".......-...-
SPECIAL PROVISIONS_ E.L.DISEASE.POLICYLIMI1 $ 500,000
OTHER
DESCRlPlIONOFOPERAlIONSILOCAlIONS/'o'EHIQ.ESIEllCl..USlDNSADOEDUYENIlOftSB'ENl/SPECIALPROYlSIOtlS
Re: All Operations
CERTIFICATE HOLDER
CANCELLATION
CITASOl
SHOULDAKYOF THE AEIOYE DESCRIBED POUClES BE CNlCEum BEFORE THE EllPlRAllOH
IlATEllIERt:OF,ltlEISSUlNolNllURERWlLLEND€AY0ll10......
30
IlAYSWRlTTEN
NOncE 10 lHE CERllFlCATEHOlDERNAIlIEO TO lHE LEFl,BUTFAIlUIIE TODO&OiloHALl.
City of Ashland
20 E. Main St.
Ashland OR 97520-1814
IMPOSENOOBLlOATJONORU.\BlI.ITYOFANYKINOUPONltlEINSURER,ITSAGENfSOR
REPRESENTATIVES.
ACORD 25 (2001108)
@ACORDCORPORATION 1988