HomeMy WebLinkAboutInsurance Certificate: Pacific Paving
ACORD_ CERTIFICATE OF LIABILITY INSURANCE OPID BE I DATE (MM/DDIYYYY)
PACI05W 09/30/10
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
KPD Insurance, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
PO Box 784 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Springfield OR 97477
Phone: 541-741-0550 Pax:541-741-1674 INSURERS AFFORDING COVERAGE NAlC#
INSURED INSURER A:. SA:IP Corporation - Salem 36196
INSURER B:
Pacific Paving, Inc. INSURER c:
PO Box 2370 INSURER D:
White City OR 97503 INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOve FOR THE POLICY PERIOD INDICATED. 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
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
11LTR ~R: POUC':' ~lU!.tBER POI;!5rJ_I:FE_c.:rJv~ei;~xPIRAT~~N LIMITS
TYPE OF INSURANCE :lATE IIIM/DDfYV' 'DATE MMlDDIYY
GENERAL UABIUTY EACH OCCURRENCE $
- PREMISES (Ea occurence\
COMMERCIAL GENERAL UABILlTY $
J ClAIMS MADE 0 OCCUR MED EXP (Anyone person) $
PERSONAL & ADV INJURY $
-
GENERAL AGGREGATE $
-
GEN'LAGG~EnE rMIT APPI~.~rIPER: PRODUCTS-COMP~PAGG $
I PRO-
POLICY JECT LOC
AUTOMOBILE LIABIUTY COMBINED SINGLE LIMIT
- $
ANY AUTO (Eaacddent)
-
ALL OWNED AUTOS BODilY INJURY
- $
SCHEDULED AUTOS (Per person)
-
HIRED AUTOS BODILY INJURY
- $
NON.QWNED AUTOS (Per accident)
f-
f- PROPERTY DAMAGE $
(Per accident)
GARAGE UABIUTY AUTO ONLY. EA ACCIDENT $
==i ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/lJMBRELLA UABIUTY EACH OCCURRENCE $
~ OCCUR 0 CLAIMS MADE AGGREGATE $
$
==i DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND X ITO~Y;;>~I~lrs I IUE~-
A - EMPLOYERS' L1ABIUTY 812919 10/01/10 10/01/n E.L. EACH ACCIDENT $50D,000
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? E.L. DISEASE. EA EMPLOYEE $ 500, 000
If yes, describe under E.L. DISEASE - POLICY LIMIT $ 500, 000
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
RE: All Operations
CERTIFICATE HOLDER
CANCELLA nON
C:ITAS02
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TI'IE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL !L DAYS WRITTEN
NOTICE TO TI'IE CERTIFICATE HOLDER NAMED TO TI'IE LEFT, BUT FAILURE TO DO SO SHAlL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON TI'IE INSURER, ITS AGENTS OR
City of Ashland
Finance Department
Attn: KariAnn Olson
90 N Mountain Ave.
Ashland OR 91520
@ACORD CORPORATION 1988
ACORD 25 (2001/08)