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ACORD'" " CERTIFICATE OF LIABILITY INSURANCE Page 1 of 2 I DATE (MMlDDlYYVY)
1.....---'" 09/1?/2010
PRODUCER 877-945-7378 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
willis of Seattle, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
26 Century Blvd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P. O. Box 305191
Nashville, TN 37230-5191 INSURERS AFFORDING COVERAGE NAIC#
INSURED JACO Environmental, Inc. IN5UAERA: Zurich American Insurance Company 16535-001
PO Box 1478 INSUREA B: Steadfast Insurance Company 26387-001
Snohomish, WA 98291
INSUAERC:
INSURER 0:
I INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREO NAMED ABOVE FOR THE POLICY PERIOO INOICATED. NOTWITHSTANOING
ANY REQUIREMENT, TERM OR CONOITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFOROEO BY THE POLICIES OESCRIBEO HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS ANO CONDITIONS OF SUCH
POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REOUCEO BY PAlO CLAIMS.
INSA DD'~ TYPE OF INSURANCE POLlCY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
A ~NERAL LIABILITY GL06?2515900 9/15/2010 9/15/2011 EAGHOCCURRENCE $ 2 000 000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 1 000 000
PREMISES Ea occurence
l CLAIMS MADE Ii] OCCUR MED EXP (Anyone person) $ 5 000
ilL WA Ston Gao Included PERSONAL & ADV INJURY $ 1 000 000
~ SIC. 000 Deductible GENEAALAGGREGATE . 2 000 000
n'L AGG~Er;lE LIMIT APnS PER: PRODUCTS-COM~OPAGG . 2 000 000
POLICY X ~~,Q.; LOC
~TOMOB1LE L1ABIL.ITY COMBINED SINGLE LIMIT .
~ ANY AUTO (Eaaccident)
e- ALLOWNEDAUTOS BODILY INJURY
.
- SCHEDULED AUTOS (Per person)
f...- HIRED AUTOS BODILY INJURY
.
NON-OWNED AUTOS (Per accident)
e-
e- PROPERTY DAMAGE .
(Peraccidenl)
RAGE LIABILITY AUTO ONLY. EAACCIDENT $
ANY AUTO OTHER THAN EAACC $
AUTO ONLY: AGG .
B ti]ESSI UMBRELLA LIABILITY SE0672516300 9/15/2010 9/15/2011 EACH OCCURRENCE . 5 000 000
X OCCUR 0 CLAIMS MADE AGGREGATE $ 5 000 000
$
R DEOUCTIBLE .
RETENTION . .
A WORKERS COMPENSATION AOS WC672515800 9/15/2010 9/15/2011 X I T"X~~;~I,~.I 10J~-
AND EMPLOYERS' LIABILITY V,"
ANY PROPRIETOAlPARTNERlEXECUTIVED ...5~L. EACH ACCIDENT . 1 000 000
OFF1CERlMEMBER EXCLUDED? .
(MandatoryinNH) E.L DISEASE. EA EMPLOYEE . 1 000 000
~~i~~S~~~~I~~~NS below E.L. DISEASE. POLICY LIMIT . 1 000 000
B OTHER CPL6?2516200 9/15/2010 9/15/2011
pollution Legal Liability $5,000,000 Per Incident
including BI/PD & Cleanup $5,000,000 Aggregate
I . 25 000 Deductible Each Incident
DESCRIPTION OF OPERATIONS f L.OCATIONSI VEHICL.ESI EXCLUSIONS ADDED BY ENDORSEMENT ISPECIAL. PROVISIONS
The Workers' Compensation policy covers California, New Mexico, Nevada, Oregon, Utah, Illinois,
Colorado, Idaho, Georgia, Maine, Massachusetts, Michigan, New Jersey, Pennsylvania, Arizona, New
York, Texas and Maine only.
The Umbrella policy also extends over the primary auto liability policy which has a $2,000,000
limit.
CERTIFICATE HOLDER
CANCELLA nON
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL. ~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOL.DER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGEN"ffi OR
City of Ashland REPRESENTATIVES.
Attn: Purchasing Representative
90 N. Mountain Avenue AUTHORIZED REPRESENTATIVE
Ashland, OR 97520 <.Tk..... ..s: ~
ACORD 25 (2009/01)
Coll: 3127890 Tpl: 1146393 Cert: 14686304 @1988-2009ACORDCORPORATION.Allrightsreserved.
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