HomeMy WebLinkAboutInsurance Certificate: Mountain View Paving
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ACORD" CERTIFICA TE OF LIABILITY INSURANCE I DATE (MMlOOfYYYY)
~. 8/31/2010
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: Ifthe 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 endorsemenUs).
PRODUCER I~~~~~I Sue Noakes, CISR, ere
Beecher Carlson Insurance Agency LLC I r.HJ1N.~" ~.. (541) 4B5~6633 I ffi~ No\: (541)485-3946
59 E 11th Ave l~~~~:sue.noakes@beecbercarlson.cam
PO Box 70206 . PRciDUC~ DD016B22
Euaene OR 97401 INSURER'S' AFFORDING COVERAGE. HAle.
INSURED INSURER A :LiberhT Northwest Ins Corn 41939
INSURER B :SAlr 52412
Mountain View Paving Inc INSURER c:
2560 E Main street INSURER 0:
INSURER E;
Ashland OR 97520 INSURER F :
COVERAGES
CERTIFICATE NUM8ER:CL10B3190542
REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD
INDICATED. NOlVI.1THSTANDlNG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT \NITH 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 CONDll0NS OF SUCH POUCIES. LIMITS SHOVVN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURAfoCE :aM~ I ,:~'ElvWY1 LIMITS
LT. POUCY NUMBER
OENeML LIAelLITY EACH OCCURRENCE I 1,000,000
- ~~:~~ ~~~t:~eoce' 100,000
~ 5MMERC1AL GENERAL UABlUTY I
A CLAlMS.MADE [i] OCCUR p09l5.211 /25/2010 19/25/2011 MED EXP (Anyone person) I 5,000
-
PERSON^L & N;JV INJURY I 1,000,000
GENERAL AGGREGATE I 2,000,000
il'~ AGG~nE~UMIT APM PER: PRODUCTS - COMPlOP AGG I 2,000,000
X POLICY ~~ lOC I
AllTOMOBILE LIABILITY COMBINED SINGLE LIMIT I 1,000,000
X (Eaaccident)
ANY AUTO
- c09l5.211 /25/2010 9/25/2011 BODILY INJURY (per person) I
A - All. OVI/NED AUTOS BODILY INJURY (per accident) I
- SCHEDULED AlITOS PROPERTY DAMAGE
I
- HIRED AlITOS (Pe1accident)
NON-OlNNED AUTOS UninSlJred motorist oombined I 1,000,000
-
OriY<l<lth<<CIOr I 1,000,000
~ UMBRELLA L1AB H ~CCUR EACH OCCURRENCE I 1,000,000
EXCESS LIAB CLAlMS.MAOE AGGREGATE I 1,000,000
X DEDUCTiBlE I
A RETENTION $ 10 000 C09154211 /25/2010 9/25/2011 I
B WORKERS COMPENSATION X 1M:; STATU. IOJ~'
AND EMPlOYERS' LIABILITY YIN
ANY PROPRIE'TORJPARTNERlEXECurIVE D EL. EACH ACCIDENT I SOD 000
OR"lCERlMEMBER EXCLUDED? NI. 0/1/2010 0/1/2011 EL. DISEASE. EA EMPLOYFF 5
(Mandatory In NH) 96578 500 000
~~~~I'h~ ~~PERATIONS belcm EL DISEASE. POLICY LIMIT I 500 000
.
DESCRIPTION OF OPERATlONSI LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, Ifmore space Is reqUiC
Re, Ashland Airport . CITY RE ORDER
CERTIFICATE HOLDER
CANCELLA liON
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS.
90 N. Mount:ain
Ashland, OR 97520 AUTHORIZED REPRESENTATIVE
~ Godfrey, Clc/sUEIlOA '/11~ 1A~
ACORD 25 (2009109)
INS025 (200909)
@1988-2009ACORDCORPORATlON. All rlghts reserved.
The ACORD name and logo are registered marl<s of ACORD