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AE~RD' I DATE (MMlDDIYYYY)
CERTIFICATE OF LIABILITY INSURANCE 05/13/2010
PRODUCER Phone: (360) 596-3700 Fax: (360)596-3703 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. ., TOO A"ORO'O RV CI'S eELOW
POULSBO WA 98370 INSURERS AFFOROING COVERAGE NAIC#
INSURED INSURER A: Travelers Casualty and Surety Co of America 31194
MARQUESS & ASSOCIATES INC INSURER B: 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.
N'R ADD' TYPE OF INSURANCE POLICY NUMBER ~~~:~~ Pg~,;v/:f..:h~N LIMITS
LTR INSR
~NERAL LIABILITY 6806146N63A OS/29/10 OS/29/11 EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY =~~~O~~~nal' $ 300,000
I CLAIMS MAOE[!] OCCUR MED. EXP (Anyone person) $ 5,000
B ~ XCU, BFPD, OCP PERSONAl & ADV INJURY $ 1,000,000
- GENERAL AGGREGATE $ 2,000,000
~'L AGGRE~ L~~I6. APPn PER: PRODUCTS.COMP~PAGG $ 2,000,000
POLICY X '.':'~... LOC $
~TOMOBILE LIABILITY BA6148N401 OS/29/10 OS/29/11 COMBINED SINGLE LIMIT
~ ANY AUTO (Eaaccident) $ 1,000,000
- ALL OWNED AUTOS BODILY INJURY
(Per person) $
- SCHEDULED AUTOS
B
~ HIRED AUTOS BODilY INJURY
~ NON-QWNED AUTOS (Per accident) $
- PROPERTY DAMAGE $
(Per accident)
RGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
OESS f UMBRELLA LIABILITY CUP3196T698 OS/29/10 OS/29/11 EACH OCCURRENCE $ 5,000,000
OCCUR D CLAIMS MADE AGGREGATE $ 5,000,000
C $
R DEDUCTIBLE $
RETENTION $ 10,000 $
WORKERS COMPENSATION AND I i"'cfR~Tt~TS I I OTHER
EMPLOYERS' LlABIUTY V'N
ANY PROPRIETORIPARTlolERIEXECUTlVE D E.L. EACH ACCIDENT $
OFFICERIIIEMBER EXCLUDED? E.L. DISEASE-EA EMPLOYEE $
(IlIlInclatoryIn NH)
11 yes, describe unOer E.L. DISEASE-POLICY LIMIT $
SPECIAL PROVISIONS below
OTHER Professional Liability 105320158 07/26/09 07/26/10 $1,000,000 Per Claim
A Claims Made Fonn $1,000,000 Aggregate
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
Water Street Bridge Project
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CERTIFICATE HOLDER
I,) J
11111
CANCELLATION
t:L JUN 1 7 2010 ~I 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 TO
20 E. Main Street I DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS
Ashland, OR 97520 AGENTS OR REPRESENTATIVES.
- AUTHORIZED REPRESENTATIVE ~ShleYtHU'~
Attention:
ACORD 25 (2009/01)
Certificate # 115217 @1988.2009ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD