HomeMy WebLinkAboutInsurance Certificate: CMC Rescue (2)
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OP 10: ME
ACORD" CERTIFICATE OF LIABILITY INSURANCE I DATE IMMtDDft'VYV)
\",.,.......-- 09/30/10
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLOER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDEO BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BElWEEN THE ISSUING INSURER(SI, AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder 18 an ADDITIONAL INSURED, the pollcy(les) muat 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 endOrBement(8).
PRODUCER 805-l180-4260 CONTACT
NAME:
Riviera Insurance Service, LLC 605-l180-4259 f,&ON:o Ext': I f~ Nol:
3710 State Sl Suite B E-MAIL
Santa Barbara, CA 93105 ADDRESS:
Chrlslopher Hili ~STOM: ID .;CMCRE-1
INSURER(SI AFFORI)ING COVERAGE HAle,
INSURED CMC Rescue INSURER A: Liberty Surplus Insurance Corp
Attn: Tamie Kennedy INSURER B :Allled Insurance
P.O. Box 8870
Sonta Borbara, CA 93160-ll870 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. NOTVVlTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VV1TH 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.
INSR TYPE OF INSURANCE :SMB~ :2M~~ UMITS
LTR POUCY NUMBER
GENERAL LIABIUTY EACH OCCURRENCE $ 1,000,00
~
A X COMMERCIAL GENERAL LIABILITY DGLLA2076232 08101/10 08101/11 PRE~~ES YE~~~ncel $ 50,00
I CLAIMS-MADE D OCCUR MED EXP (Anyone person) $ 5,00
- PERSONAL & ADV INJURY $ 1,000,00
~ GENERAL AGGREGATE $ 2,000,00
rl'L AGG~E~~~r ~L1MIT APnS PER: , PRODUCTS - COMPIQP AGG $ 2,000,00
POLICY ~fg. LOC $
AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT $ 1,000,00
f-- !ACP7804601910 (EaaCCident)
B ~ ANY AUTO 08101/10 08101/11
BODILY INJURY (Per person} $
I- ALL OWNED AUTOS BODILY INJURY (Per accident) $
I- SCHEDULED AUTOS PROPERTY DAMAGE .
$
I- HIRED AUTOS (Per aCCident}
NON-QWNED AUTOS $
I- $
UMBRELLA lIAS ,H ~CUR EACH OCCURRENCE $
- EXCESS lIAS
CLA.lYS_MADE AGGREGATE $
- DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION IT~;T~I~!:. I F~~-
AND EMPLOYERS' UABIUTY VfN
ANY PROPRIETOR/PARTNER/EXECUTIVE D E.L, EACH ACCIDENT $
OFFICERIMEMBER EXCLUDED? Nf'
(Mandatory In NHI E.L DISEASE - EA EMPLOYEE $
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Atblc::h ACORD 101, Additional Rem.rks Sc::hedule, If mo,. Sp8c::e Is nlqul,.dl
Proof of Insurance
CERTIFICATE HOLDER
CANCELLATION
ASH-455
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE
THE EXPIRAnON DATE THEREOF, NonCE WILL BE DEUVERED IN
Ashland Fire & Rescue ACCORDANCE WITH THE POUCY PROVISIONS.
455 Siskiyou Blvd AUTliORIZED REPRESENTATIVE
Ashland, OR 97520 ~//~
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ACORD 25 (2009/09)
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