HomeMy WebLinkAboutInsurance Certificate: Kaylor Electric
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~RD(f) CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDlYYYY)
OP ID JT 06/22/10
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 BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. - . -
IMPORTANT: If the certificate holder is an ADDITIONAl INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, 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:
Insurance Marketplace, Inc. [AiC'....No, Ext): I (AlC, No).
1998 Skypark Dr Suite 100 ADDREss:
Medford OR 97504 CUSTOMER 10 II: KAYLO-1
Phone:541-779-0177 Fax: FAX 772-8235 INSURER(S) AFFORDING COVERAGE NAle#
INSURED INSURER A : Travelers
Kablor Electric, LLC INSURER B : Saif Corporation
P. . Box 639
Phoenix OR 97535 INSURER C :
INSURER 0 :
INSURER E :
INSURER F :
COVERAGES
CERTIFICATE NUMBER:
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. NOlWlTHSTANDING 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OF INSURANCE INSR WVO POLICY NUMBER (MMioofYYYY) (MMIOD1YYYY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE .1,000,000
A rx COMMERCIAl GENERAL LIABILITY 680-0891R565 07/01/10 07/01/11 PREMISES (E~~~~~~nce) . 100,000
[ CLAIMS-MADE [!] OCCUR MED EXP (Anyone person) . 5,000
- X PERSONAL & ADV INJURY .1,000,000
GENERAL AGGREGATE .2,000,000
- '2,000,000
~'L AGG~EnE LIMIT APnS PER: PRODUCTS - COMP/OP AGG
POLICY r;~gT LOC .
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT '1,000,000
- (Eaaccident)
A -.!... ANY AUTO BA-0895R877 07/01/10 07/01/11 BODILY INJURY (Per person) .
All OWNED AUTOS BODILY INJURY (Per accident) .
-
- SCHEDULED AUTOS PROPERTY DAMAGE
.
~ HIRED AUTOS (Per accident)
~ NON-QWNED AUTOS .
.
UMBRELLA L1AB H ~CCUR . EACH OCCURRENCE .
I- EXCESS L1AB
CLAIMS-MADE AGGREGATE .
"- DEDUCTIBLE .
RETENTION . .
B WORKERS COMPENSATION 448917 0"/01/10 0"/01/11 X IrORY LIMITS I IUE~-
AND EMPLOYERS' LIABILITY V,N
ANY PROPRIETORfPARTNER/EXECUTITI 'A E.l. EACH ACCIDENT .500000
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) . E.L. DISEASE - EA EMPLOYEE .500000
~~~~~~tT~N On~bPERATIONS below E.L. DISEASE - POLICY LIMIT .500000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITYJAC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Ashland
Kerry AUTHORIZED REPRESENTATIVE
20 E. Main
Ashland OR 97520 R. Scott Weaver, CIC
ACORD 25 (2009/09)
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