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OP 10: LB
ACORD- CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDlYYYYI
~. 11/17/10
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 HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(iesl must be endorsed. .If SUBROGATION IS WAIVED, subject to .
the terms and conditions of the policy, certain policies may require an endorsement. A statemen~ on thls;cert:lflcatedoesJ not-confer rights to the-;
certificate holder in lieu of such endorsementl~). " . - -- I -
PRODUCER .' ., 36.0-293-2135 CONTACT ..' t I', ..... I.
I ~~,- L I I NAME: " I -.. .--- - .- ..
RIS Insurance Services;r: ,"CC' 360-293-2385 PA~gNJo Extl: I 1-'':1 ...;. '1'-;'~'Jr~~ Nol: . -- - - .
- ----.-----
PO Box 1059--' I I , E-MAIL , I .J-"; ~_'Il Hi.... ''-'' "
I ADDRESS: -. ..0-._ . .----
Anacortes .WA98221.--.--- I , ~~~~~~~~ 10 II: ENGIN-1 , ..'.. d., . .. .. -_.- ,
' ' . -- -- -.
Lois Bonner .
. INSURERfS} AFFORDING COVERAGE NAlC#
INSURED ENGINEERED MONITORING INSURER A; Western National Assurance 24465
SOLUTIONS INSURER B :
20345 SW PACIFIC HWY # 104 INSURER C :
SHERWOOD, OR 97140 INSURER 0 :
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.
I~f: TYPE OF INSURANCE ~~"'oL ,~.~. ~3~%TY~~YI POLICY EXP L.IMITS
POLICY NUMBER MMIDDIYYYY
GENERAL. UABlLlTY EACH OCCURRENCE $
f--
COMMERCIAL. GENERAL LIABILITY . - g~~~ls~~9E~~~E~ncel $
. I CLAIMS-MADE 0 OCCUR - MED EXP (Anyone person) $ - - --- ..
,i:. '. '.
. .. -~--~" . - .". PERSONAL & ADV INJURY .. $ - . ..
"1:--- -, ..... . . - .- -- ..
-- GENERALAGGREGATE~ $ -- .-.---
t---"'. ...;".' -- - .h . .- .
.. n'l:AGG~EnE LIMIT A~~t PER: " h PRODUCTS - COMPIOP AGG $ - .... - - -.
,.,....
POLICY I ~bW,: LOC .. . I- . $
AUTOMOBILE LIABILITY; '. COMBINED SINGLE LIMIT $ '1,000,000
f-- (Eaaccident)
A ANY AUTO CPPl 004437 02 12103/10 12/03/11
f-- BODILY INJURY (Per person) $
I-- ALL OWNED AUTOS BODILY INJURY (Per accident) $
f-- SCHEDULED AUTOS PROPERTY DAMAGE
$
~ HIRED AUTOS (Peracddent)
~ NON-OWNED AUTOS $
$
UMBRELLA LIAB H OCCUR EACH OCCURRENCE S
-
EXCESS LIAB CLAIMS.MADE AGGREGATE $
- DEDUCTIBLE . $ n
~
RETENTION $ $
WORKERS COMPENSATION I Twe STATU', I IOJb"
AND EMPLOYERS' LIABILITY VIN
ANY PROPRIETORIPARTNER/EXECUTIVE 0 N/A E.L. EACH ACCIDENT $
OFFICERndEMBER EXCLUDED?
(Mandatory In NH) E.L. DISEASE. EA EMPLOYEE S
If yes, desaibe under E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS below
A Physical Damage CPP100443702 12/03/10 12/03/11 $500 OED Comp & C?I
Hired Auto 50,000 Uml
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remar1o:s Schedule, If mora space Is required)
attn:KARIOLSON CITY RECORDER
541-488-5320
CERTIFICATE HOLDER
CANCELLATION
CITYASl
CITY OF ASHLAND
90 N MOUNTAIN AVE.
ASHLAND, OR 97520
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE lICY PROVISIONS.
AUTHORIZED REPRESENTATN
Lois Bonner
ACORD 25 (2009/09)
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