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,""CORV' CERTIFICATE OF LIABILITY INSURANCE 1113012010
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 BElWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRE"~NT"TIV~ nA PRE CERTlFI~ATE H"LDER
IMPORTANT: If the certificate holder's en ADOmONAL INSURED, the pollcy(I..) must be .ndo....d. If SUBROGATION ts WAIVED, subject to
tha tann. end conditions of the policy, certlln pollcl.. may require an .ndo........nt. A atatemant on this certificate do.. not eom.r rights to the
certiflcate holder In lieu of such andorHmentls}.
....OOUCER PhonI;: 503-365-7001 Fu: 503-365-7354 CONTACT SLATER & ASSOCIATES INSURANCE
MID VALLEY GENERAL AGENCY LLC 1;"~Ne_ ~_ 1503-624-0466 r,:", "" 1503-624-0646
4305 RIVER ROAD N I~~..... (first name) @Slaterfn8urance.com
KEIZER OR 97303 I~~~~I"" 19476
INSURERrs) AFFORDfNQ COVERAGE NA~'
INSURED INSURER'" ,SCOTTSDALE INSURANCE COMPANY 41297
ENGINEERED MONITORING SOLUTIONS LLC
617 N MAIN ST INSURER8 :
NEWBERG OR 97132 INSURER C :
INSURER D:
INSURERE :
INSURERF:
COVERAGES
CERTIFICATE NUMBER: 47201
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
~,ER!.I~~?~~ MAY BE ISSUED OR MAY P~~~~~, THE INSURANCE AFFORDED BY THE P~~~~~.S ,D;,Sa~~~ED HEREIN IS SUBJECT TO ALL THE TERMS,.
.l,~ TYPE OF INSURANCE ~~ = POUCY NUMBER POLlCY!FI' POLICY UP UIIITS
."'"
A GENERAL LIABILITY CPSll04202 12/03110 12/03111 EACH OCCURRENCE . 1,0,00,,000
-
-.! D~ERCIAl GENERAl LlABlllTY DAMAGE TO RENTED . 1,00,,000
,
- CLAIMS-MADE 1)(1 OCCUR MED. EXP (Any one penon) . 5..000
- PERSONAl. & N:JV INJURY . 1,0,00,,000
- GENERAL. AGGREGATE . 2,0,00,,000
~1. AGG:iiJAlE~~~ APM: PER: PRODUCTS - COMPIOP AGG . 2,0,00,,000
POLICY lOC .
AUTOIII081LI UAIIIUTY COMBINED SINGLE LIMIT .
- (ElIIOCident)
- ANY AUTO BODILY INJURY (Per pmon)
.
- All OWNED AUTOS BODilY INJURY (Per Iccident)
.
>--- SCHEDULED AUTOS PROPERTY DAMAGE
HIRED AUTOS I fPerlccldentl .
>---
>--- NOJlf.OWNED AUTOS .
.
I- UMBRELLA ,~o H ~CUR EACH OCCURRENCE .
!!XCEn ,~o CLAIMS-MADE AGGREGATE .
- DEDUCTIBLE I.
RETENTION . .
WORKfRI; COMI"!NSATION I ~~T~M I I OTH .
AND EMPLOYl:Ra" LIABILITY v.. I.
ANY PROPRI!TORIP'ARTNERIlX!CUTIVI 0 E.l. EACH ACCIDENT
OFFlClUt/IIl!MDER EXCLUDED? .,. E.l. DISEASE-EA EMPLOYEE I ..
(M.ndalorylnNH)
If I'M. dna1be........ E.l. DISEASE-POLICY LIMIT
DESCRIPTIO,", OF OPERATIO,",S beIaw .
DESCRlPTlON OF OPERATlONS f LOCAnONS I VEHICLES (Attach ACORD 101, Additional R_rluI Schedur., If more .pac. J. rwqulred)
CITY OF ASHLAND IS INCLUDED AS ADDITIONAL INSURED PER CG2010(7104)
CERTIFICATE HOLDER
CANCELLATION
CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
90 N MOUNTAIN AVE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
ASHLAND, OR 97520
AlJ1lK)RJZEl) REPRESENTATIVE
Attention: KARl OLSON MID VAlLEY GENERAl AGENCY LLC \-l ~ .e ';()-'
Herman R Deiss
ACORD 25 (2009/09) e11988-2009 ACORD CORPORATION, All rights ..oorvod,
The ACORD name and logo are registered marks of ACORD
, .
.
POLICY NUMBER: CPS1104202
EINGINEERED MONITORING SOLUTIONS, LLC
COMMERCIAL GENERAL LIABILITY
CG 20 10 07 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Location/sl Of Covered Onerations
Or Oraanlzatlonlsl:
CITY OF ASHLAND
90 N MOUNTAIN AVE
ASHLAND, OR 97520
ATTN:KARIOLSON
POLICY PERIOD: 12-03-2010 TO 12-03-2011
Information reouired to comolete this Schedule if not shown above, will be shown in the Declarations.
A. Section II - Who Is An Insured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury", "property
damage" or "personal and advertising injury"
caused, in whole or in part, by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your
behalf;
in the performance of your ongoing operations for
the additional insured(s) at the location(s) desig-
nated above,
CG20100704
B. With respect to the insurance afforded to these
additional insureds, the following additional exclu-
sions apply:
This insurance does not apply to "bodily injury" or
"property damage" occurring after:
1. All work, including materials, parts or equip-
ment furnished in connection with such work,
on the project (other than service, maintenance
or repairs) to be performed by or on behalf of
the additional insured(s) at the location of the
covered operations has been completed; or
2. That portion of "your work" out of which the
injury or damage arises has been put to its in-
tended use by any person or organization other
than another contractor or subcontractor en-
gaged in performing operations for a principal
as a part of the same project.
@ 150 Properties, Inc., 2004
CJ
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