HomeMy WebLinkAboutInsurance Certificate: Soda Inc
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ACORD" CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDNYYV)
~ 10/18/2010
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
aELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER. AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain s~.OIiCies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s .
PRODUCER ~2~~~CT Pam Breazeale
-
Beecher Carlson Insurance Agency LLC J.&NJo Extl' (541) 494-2655 W"
/AlC No}: (S-U)494-2755
707 Murphy Rd i:o~~ss: pam. breazeale@beechercarlson.com
~~~~g~~JOJ'P 0 0 0 5112
Medford OR 97504 INSURERIS\ AFFORDING COVERAGE HAle #
INSURED INSURER A :Philadelphia Insurance / Tokio
INSURER B :
Soda Ine INSURER C :
604 South 2nd St INSURER D :
INSURER E :
Central Point OR 97502 INSURER F :
COVERAGES
CERTIFICATE NUMBER:I0 -11 GL
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 OESCRI8ED 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 I~.~E: SJ:~! &~M5~W{l I I&OLlCY EXP
LTR POLICY NUMBER MMIDDNYYY LIMITS
GENERAL LIABILITY ~~CCURRENCE $ 1,000,000
-
X COMMERCIAL GENERAL LIABILITY ~~~~~~9~~~u~~nce\ $ 100,000
A l CLAIMS-MADE [i] OCCUR HPK619567 10/4/2010 10/4/2011 MED EXP (Anyone person) $ 5,000
- PERSONAL & ADV INJURY $ EXCLUDED
- GENERAL AGGREGATE $ 2.000,000
~'L AGG~EnE LIMIT APnS PER: PRODUCTS. COMPIOP AGG $ 2,000,000
X POLICY ~~9.,: LOC $
~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $
(Eaaccident)
- ANY AUTO BODILY INJURY (Per person)
$
- ALL OWNED AUTOS BODILY INJURY (Per accident) $
- SCHEDULED AUTOS PROPERTY DAMAGE
$
- HIRED AUTOS (Per accident)
- NON..()WNED AUTOS $
$
- UMBRELLA lIAB R OCCUR EACH OCCURRENCE $
EXCESS lIAB CLAIMS-MADE AGGREGATE $
- DEDUCTIBLE $
RETENTION $ '1 $
WORKERS COMPENSATION LlJ6F STATU-" I IOJ~-
AND EMPLOYERS' LIABILITY VIN RY...L!M1TS
ANY PROPRIETOR/PARTNER/EXECUTIVE 0 NI' EL EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH) E.L DISEASE - EA EMPLOYEE $
~~s(:~f~~r~~ On~bpERATIONS below EL DISEASE - POLICY LIMIT $
I
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
Verification of insurance.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS.
Finance Department AUTHORIZED REPRESENTATIVE
Attn: Lee Tuneberg
20 E Main Street
Ashland, OR 97520 ILl, Ikr
Pam Breazeale/PAMBRB
ACORD 25 (2009/09)
INS025 (200909)
@ 1988-2009 ACORD CORPORATION. All rights reserved.
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