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HomeMy WebLinkAboutInsurance Certificate: Potelco Inc /"""""'\ ACORD" CERTIFICATE OF LIABILITY INSURANCE I DATE (MMfDDIYYYY) ~ 11n PRODUCER John L. Wortham & Son, L.P. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION P. O. Box 1388 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR Houston, TX 77251-1388 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 713-526-3366 713-526-5587 INSURERS AFFORDING COVERAGE NAIC# INSURED Potelco. Inc. INSURER A:. Old Renublic Insurance Comnanv 24147 14103 Stewart Rd. INSURER B: Ace Pronertv & Casualtv Insurance Co. 20699 Sumner WA 98390 INSURER c: INSURER D: I INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NQlWITHSTANDING 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 POLlCIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ',N';;: -:.~~';:, ~D. POLlCY NUMBER POL.ICY EFFECTIVE ~<I~~! EXPIRATION LIMITS A ~NERAL UABIUTY MWZY58873 8/1/2010 8/1/2011 EACH OCCURRENCE I 5000,000 I COMMERCIAL GENERAL LIABILITY PREMlseJ ?E~~~enC8\ I 5.000.000 - W CLAIMS MADE [Z] OCCUR MED ex? 'ArIv one person\ I!xcluded - PERSONAl & ADV INJURY I 5,000.000 - GENERAL AGGREGATE I 5,000.000 -7l'L AGG~EnE ILlMIT APnSIPER: PRODUCTS - COMP/OP AGG I 5,000.000 I POLICY ~~,9; LOC A ~TOMOBIL.E UAB1UTY MWTB21029 8/112010 8/112011 COMBINED SINGLE LIMIT I ~ ANY AUTO (Es8ccidenl) 5,000.000 -'- ALL OWNED AUTOS BODilY INJURY I SCHEOULED AUTOS (Perpsrson) - i HIRED AUTOS BOOll Y INJURY I NON-OWNED AUTOS (Peracddent) - PROPERTY DAMAGE I (PlIraccident) ~RAGE LIABILITY AUTO ONLY. EA ACCIDENT I ANY AUTO OTHER THAN EA ACe I AUTO ONLY: AGG I B 5ESS I UMBREL.LA LIABIUTY XOOG25908041 8/1/2010 8/1/2011 EACH OCCURRENCE I 5,000,000 OCCUR [Z] CLAIMS MADE AGGREGATE I 5,000,000 eM Retro Date 8/1/2002 I ;1 DEDUCTIBLE I I RETENTION $ Der Dolicy I A WORKERS COMPENSATION MWC 11672400 8/1/2010 8/1/2011 if I T"X~~T~N;.I IOJ,tl- AND EMPLOYERS' LIABILITY YI" ANY PROPRIETOR/PARTNER/EXECUTIVE [!!] E.L EACH ACCIDENT I 1 000 000 OFFICERlMEMBER EXCLUDED? N (Mandatory In NH) E.L DISEASE - EA EMPLOYE I 1 000 000 ~~~~I~S~~b~VIS1~NS below E.L DISEASE. POLlCY LIMIT I 1 000 000 OTHER DESCRIPTION OF OPERATIONS' LOCATIONS /VEHICL.ES 'EXCL.USIONS ADDED BY ENDORSEMENT' SPECIAL PROVISIONS Re: All Operations General Liability And Auto Liability Policies Include The City Of Ashland, Oregon, And Its Elected Officials. Officers And Employees As An AddiUonallnsured When Required By Written Contract But Only As Respects Liability Arising Oul Of Named Insured's Work For AddiUonallnsured. CERTIFICATE HOLDER CANCELLATION SHOUL.D ANY OF THE ABOVE DESC RIBED POLICIES BE CANCEL.LED BEFORE THE EXPIRATION The City Of Ashland, Oregon DATE THEREOF, THE ISSUING INSURER WlL.L. ENDEAVOR TO MAIL. ..1Q... DAYS WRITTEN Attn: Kari Ann Olson NOTICE TO THE CERTIFICATE HOL.DER NAMED TO THE L.EFT, BUT FAlL.URE TO DO SO SHALL 90 N. Mountain Ave. IMPOSE NO OBLIGATION OR UABIL.ITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Ashland OR 97520 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE John L Wortham & Son. L vrrlvvt.. !Jj,Jd:h4g - ~LI ACORD 25 (2009/01) @1988.2009ACORDCORPORATION. All rights rOBorvod. CERT NO.' 7861792 CLIENT CODE: 10QUANTSER (HOU) Sandy Moore 7/18/2010 12:28 10 PH Page 1 of 2