HomeMy WebLinkAboutInsurance Certificate: Metal Masters
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~RD" CERTIFICATE OF LIABILITY INSURANCE OPID KIY I DATE (MMlDDNYVY)
10/06/10
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 HOLOER.
IMPuRTAN I: IT tne certificate holder IS an ADDITluNAL IN~uRED,tho POllcY\leS, must be endorsed. If SUBROGATION IS WAIVED, subject to
the tenns 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 NAME~'" .
Protectors Insurance, LLC !",~~Ntfo Extl: I iAiC. No):
Pi10t Rock Ins Agency LLC (CA)
PO Box 4669 ~DMDA~~ss:
Medford OR 91501 CUSTOMER 10 #: METAL-1
Phone: 541-113-5358 Fax:541-112-1906 INSURER(S) AFFORDING COVERAGE NAlC .
INSURED INSURER A : Liberty Northwest Insurance 41939
Metal Masters Inc INSURER B : SAIF Corporation
3825 Crater Lake Hwy
Medford OR 91504 INSURER C :
INSURER D :
INSURER E :
INSURER F :
COVERAGES
CERTIFICATE NUMBER:
REVISION NUMBER:
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ILTR TYPE OF INSURANCE INSR Wi POLICY NUMBER (MMlDDfYYYY) (MWDOivYYY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE .1,000,000
-
A X COMMERCIAL GENERAL LIABILITY Cl1150259 10/01/10 10/01/11 PREMISES ("Ea occurrence) .100,000
I CLAIMS-MAOE ~ OCCUR MED EXP (Any one person) .5,000
- PERSONAL & ADV INJURY .1,000,000
GENERAL AGGREGATE .2,000,000
- .2,000,000
-il'~ AGG~EnE LIMIT APPlS PER: PRODUCTS - COMP/OP AGG
X POLICY ~r2T LOC .
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT . 1,000,000
- (Eaaccident)
A ~ ANY AUTO Cl1150259 10/01/10 10/01/11 BODILY INJURY (Per person) .
ALL OWNED AUTOS BODILY INJURY (Per accident) .
-
- SCHEDULED AUTOS PROPERTY DAMAGE
.
- HIRED AUTOS {Per accident)
NON-OWNED AUTOS .
- $
A UMBRELLA LIAB ~ OCCUR Cl1150259 10/01/10 10/01/11 EACH OCCURRENCE .1,000,000
-
EXCESS LIAB CLAIMS-MADE AGGREGATE .1,000,000
- DEDUCTIBLE ~~ ,,~, ,,',> --.:, n ~ 7~J~ 1 .
, e-= 'I 1,:,--:;
RETENTION . ,I .-":: ,_ "7. "__ .
B WORKERS COMPENSATION B12r~\ 10/01/;[0 10/01/11 X Irti',\W,ili}'s I IU~R'-
AND EMPLOYERS' LIABILITY YIN I
ANY PROPRIETORlPARTNERlEXECUTU IA OCT 1 2 2 10 I E.L. EACH ACCIDENT .1,000,000
OFFICERlMEMBER EXCLUDED? 1-
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE .1,000,000
~~S(;~lPir~~ OnFdOPERATIONS below E.L. DISEASE - POLICY LIMIT .1,000,000
I ~ - J
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remartl.s Schedule, if more space is required)
-
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITYASH THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELrvERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Ash1and AUTHORIZED REPRESENTATIVE
Ci ty Hall
Ashland OR 91520 Dennis C. Flenner
I
ACORD 25 (2009/09)
@198B-2009ACORDCORPORATION. All rights reserved.
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