HomeMy WebLinkAboutInsurance Certificate: Pump Pipe & Tank Services
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ACORD' CERTIFICATE OF LIABILITY INSURANCE I DATE IMM/DDlYYYY)
~ 10/20/10
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(les) must be endorsed, If SUBROGATION IS WAIVED, subject to
the terms 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 817-640-5035 CONTACT
NAME:
Monroe & Monroe Insurance 817-640-0131 PHONE I r~~ No\;
Ale No Ext:
Agency, Ltd, E-MAil
2921 Galleria Dr" Suite 102 ADDRESS:
~~g~~~~~ /0 II: PUMPP-1
~r1in~~on, l!,!6011 INSURER/51 AFFORDING COVERAGE NAICII
INSURED Pump Pipe & Tank Services INSURER A ,Mid-Continent Casualtv Co, 23418
Robert 0 McHenry INSURER B :
Box 146 INSURER C :
Talent, OR 97540 INSURER 0 :
INSURER E :
INSURER F:
COVERAGES
CERTIFICATE NUMBER'
REVISION NUMBER'
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEO 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.
INSR TYPE OF INSURANCE pouey EFF ~M~l UMITS
LTR pouey NUMBER MM/DOIVYYY
GENERAL LIABIUTY EACH OCCURRENCE S 1,000,00
-
A X COMMERCIAL GENERAL LIABILITY 04GL806721 11/15/10 11/15/11 I PREMISES ~E~~~~ence\ S 100,00
) CLAIMS-MADE W OCCUR MED EXP (Anyone person) S (
X Pollution L1ab PERSONAl 8. ADV INJURY S l,OOO,OO(
c!. Professional L1ab GENERAL AGGREGATE S . 3,OOO,OO(
~'l AGG~l~IEllIMIT APnSIPER: PRODUCTS - COMPIOP AGG S 3,OOO,00(
X POLICY , ~c-PT lOC s
AUTOMOBILE LIABIUTY COMBINED SINGLE LIMIT S
>- (Eaaccident)
>- ANY AUTO BODilY INJURY (Per person) S
>- All OWNED AUTOS BODilY INJURY (Per accident) S
e- SCHEDULED AUTOS PROPERTY DAMAGE
S
~ HIRED AUTOS (Per accident)
NON-QWNEO AUTOS S
e-
S
- UMBRELLA LIAB H ~CCUR EACH OCCURRENCE S
EXCESS UAB CLAIMS-MADE AGGREGATE S
- DEDUCTIBLE . S
RETENTION S S
WORKERS COMPENSATION I T'X~JT~T.~; I IOJ~-
AND EMPLOYERS' LIABIUTY YIN
ANY PROPRIETORJPARTNERJEXECUTIVE 0 NIA E.L EACH ACCIDENT S
OFFICERIMEM8ER EXCLUDED?
(Mandatory in NH) E.l. DISEASE. EA EMPLOYEE $
g~s~~rp'frb~ ~iJPERAT10NS below E.l. DISEASE. POLICY LIMIT S
A Equipment Floater 041M40911 11/15/10 11/15/11 Owned Equ 4,90
DESCRIPTION OF OPERATIONS J LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more space Is required)
CERTIFICATE HOLDER
CANCELLATION
CASHLAN
RECEiVED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
20 E. Main Street
Ashland, OR 97520 NOV 3 0 2010 AUTHORIZED REPRESENTATIVE
C7tf~ ,
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ACORD 25 (2009/09)
'.'''.) v, . h'" <laD _: @1988.2009ACORDCORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD