HomeMy WebLinkAboutInsurance Certificate: Dry Creek Landfill
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ACORD'" CERTIFICATE OF LIABILITY INSURANCE I DATE (MMJODfYYYY)
~ 9/29/2010
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANO CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMENO, EXTEND OR ALTER THE COVERAGE AFFOROEO BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE OOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PROOUCER, AND THE CERTIFICATE HOLOER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(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 CONTACT
NAME:
Welts Fargo Insurance Services USA, roc r.6.~~NJn I=vll' lr~Nol:
E-MAIL
975 Oak Street, Suite 900 ADDRESS:
~~~~~~~: 10., ROGUEWAST
Eugene, OR 97401 INSURER/SI AFFORDING COVERAGE NAle.
INSURED INSURER A: Everest National Insurance Company 10120
Dry Creek Landfill, Inc. INSURER B : Axis Surplus Insurance Company 26620
PO Box 3167 INSURER C:
INSURER D :
.-. '- .. INSURER E : - . .. .. . - .. -
Central Point, OR 97502
INSURER F:
COVERAGES
CERTIFICATE NUMBER: 1838587
REVISION NUMBER: See below
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INOICATEO. 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 ==t'IMITS SHOWN MAY HAVE BEEN REOUCEO BY PAlO CLAIMS,
1~1: TYPE OF INSURANCE POLlCY NUMBER :~Mg~ I f=31J~~ LIMITS
A GENERAL LIABILITY 72SW000497101 10/1/2010 10/1/2011 EACH OCCURRENCE . 1,000,000
X ' ~~MAG~~ ?tE~!:~ . 100,000
COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrencel
I CLAIMS-MADE 0 OCCUR MEO EXP (Anyone person) . 5,000
X $1 ,000 BIIP.D Deduct. PERSONAL & ADV INJURY . 1,000,000
~ ..
.. , GENERAL AGGREGATE . 2,000,000
- PRODUCTS - COMPIOP AGG
~~ AGG~EnE liMIT APf~S PER: . 2,000.000
POLICY ~~R;: . LOC .
AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT
- (Eaaccidenl) .
"
- ANY AUTO BODILY INJURY (Par person) .
- All OWNED AUTOS BODILY INJURY (Per accident) .
- SCHEDULED AUTOS PROPERTY DAMAGE
.
- HIRED AUTOS (Per accident)
NON-OWNED AUTOS .
-
.
B UMBRELLA LIAS M ~CCUR ELU755140012010 10/1/2010 10/1/2011 EACH OCCURRENCE . 3,000,000
X EXCESS L1AB CLAIMS-MADE AGGREGATE . 3,000,000
- ~ -. ..
- DEDUCTIBLE .
RETENTION . .
WORKERS COMPENSATION I T~~~mI,~-" I I DJbi'
AND EMPL.OYERS' UABIL.1TY YIN
ANY PROPRIETORlPARTNERlEXECUTIVE D E.l. EACH ACCIDENT .
OFFICER/MEMBER EXCLUDED? NIA
(Mandatory In NH) E.l. DISEASE - EA EMPLOYE .
g~~~~iprr8~ O~OPERATIONS below E.l. DISEASE. POLICY LIMIT .
DESCRIPTION OF OPERATIONS IlQCATIONS I VEHICLES (Attach ACORD 101, AddlUonal Remarkl Schedule, If more Ipacell required)
City of Ashland its officers, agents and employees are added as additional insureds.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Attn City Administrator
20 E Main AUTHORIZED REPRESENTATIVE 9(~-
Ashland OR 97520
,
ACORD 25 (2009/09)
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