HomeMy WebLinkAboutInsurance Certificate: Keller Associates (2)
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~R " CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDfYYYY)
OP 10 RC 12/08/10
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
lMPORTANT: lfthe eertmeate holder IS an ADDITIONALINSURED, the pOliey(ieSf must be endorsed;~1f SUBKUuATIUN 15 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 NAME:
The Hartwell Corporation - Cal I r~g,Ntio Ext': Ir~,NOI'
PO Box 400 11o~A~SS:
Caldwell ID 83606 CUSTOMER ID #: KELLE 4
Phone:208-459-1678 Fax:208-454-1114 INSURERISj AFFORDlNG COVERAGE NAIC#
INSURED INSURER A : Travelers Indem Co of America 25666
Keller Associates, Inc. INSURER B : Libertv Ins, Underwriters
131 SW 5th Avenue, Suite A
Meridian ID 83642 INSURER C : Traveler.. Casual ty . Surety
INSURER 0 : Travelers Indemnity of CT 25682
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 INSR I~D POLICY NUMBER (&~ME~) 1&:1'BE~) LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1000000
e-
A X COMMERCIAL GENERAL LIABILITY PREMlS~S (Ea occurrence\ $ 1000000
I CLAIMS-MADE [!J OCCUR MED EXP (Any one person) $ 10000
e- X 6807877L1l8 12/01/10 12/01/11 PERSONAl 8. ADV INJURY $ 1000000
>-- GENERAL AGGREGATE $ 2000000
h'L AGG~rilE LIMIT APnS PER: PRODUCTS - COMP/OP AGG $ 2000000
POLICY X ~~gi LOC $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000
>-- (Eaaccidenl)
D 0- ANY AUTO BODILY INJURY (Per person) $
L- ALL OWNED AUTOS BA7877L468 12/01/10 12/01/11 BODILY INJURY (Per accident) $
>-- SCHEDULED AUTOS X PROPERTY DAMAGE
0- HIRED AUTOS (Peraccidenl) $
0- NON-OWNED AUTOS $
$
UMBRELLA L1AB H-OCCUR EACH OCCURRENCE $
L-
EXCESS L1AB CLAIMS-MADE AGGREGATE $
e- DEDUCTIBLE .
RETENTION $ $
C WORKERS COMPENSATION UB9~22YOB1 05/01/10 05/01/11 X ITS'<<iLI~IVs I IU~~-
AND EMPLOYERS' LIABILITY
V'N INCL WA STOP GAP .1,000,000
ANY PROPRIETORlPARTNERlEXECUTIVD E.L. EACH ACCIDENT
OFFICERlMEMBER EXCLUDED? ,.
(Mandatory In NH) E.L. DISEASE - EA EMPLOYEE .1,000,000
If yes, describe under .1 000 000
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT
B Prof, Liab. AEE1968860110 12/01/10 12/01/11 Ea, Claim $2,000,000
$100 000 Deduct Ann, Aaa, $2.000,000
DESCRIPTION OF OPERATIONS I LOCATIONS {VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
The City of Ashland, ore~on, its elected officials, officers and employees
are add1tional insureds or general liability and auto liabilit~ when
re~ired by contract and as provided by attached policy forms C 0381 and
CA 437,
CERTIFICATE HOLDER
CANCELLATION
ASHLA02
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Ashland
25 E Main Street
Ashland OR 97520
AUTHORIZED REPRESENTATIVE
ACORD 25 (2009/09)
@ 1988-2009 ACORD CORPORATION. All rights reserved.
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