HomeMy WebLinkAboutInsurance Certificate: Pump Pipe & Tank
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ACORD' CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDOtyYVYI
~. 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
IMP.QRTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be en~orsed: If S~~ROGATlgN I~ .WAIV.ED, ~ubj~ct 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). " , "
---..- . . 817-640-5035 CONTACT
PRO?~7E~-.:.~. '_ ?<.~; _'. ,. : , NAME: " :;~. .- , -.
Monroe&-Monroe lrisurance- ---- 817-640-0131 rl:gN~o Extl: --I ,rt~ Nol; ~.~
'. .
Agency; Ltd. E-MAIL ,
2921 Galleria Dr., Suite 102 ADDRESS:
Arlington, TX 76011 ~~~~~~~~ ID #: PUMPP-1
.Jim.Bo'~ (',(' INSURERISI AFFORDING COVERAGE NAIC#
INSURED Pump Pipe & Tank Services INSURER A : Mid-Continent Casualty 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 ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REOUIREMENT, 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 POLICY EFF POLICY EXP LIMITS
LTR POLICY NUMBER MMIODNYYY MM/DDNYYY
GENERAL UABILlTY EACH OCCURRENCE 0 1,000,000
A 'x COMMERCIAL GENERAL LIABILITY 04GL806721 11/15/10 11/15/11 PREMISES tE~~~~nce\ 0 100,000
I CLAIMS-MADE 00 OCCUR MED EXP (Any ()(\e person) 0 0
X Pollution Llab ... PERSONAL & ADV INJURY' 0 1,000,000
I--'-'- . ..
X Professional Llab . GENERAL AGGREGATE 0 . 3,000,000
, '.
f-'--', .. .... .. - .. .. 3,000,000
Iil'L AGG~EnE ,LIMIT APFlS\PER PRODUCTS -: COMP/OP AGG 0
X POLICY . P'~RT lOC ,. .,c' 0
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 0
f- (Eaaccident)
f- ANY AUTO BODilY INJURY (Per person) 0
f- ALL OWNED AUTOS BODilY INJURY (Per accident) $
f- SCHEDULED AUTOS PROPERTY DAMAGE
0
f- HIRED AUTOS (Per accident)
NON-OWNED AUTOS 0
f-
0
UMBRELLA LIAS H ~CCUR EACH OCCURRENCE 0
-
EXCESS LIAS CLAIMS-MADE AGGREGATE 0
- DEDUCTIBLE 0
RETENTION 0 0
WORKERS COMPENSATION I T~~~T:}~N!:.1 IOJ~-
AND EMPLOYERS' LIABILITY VIN
ANY PROPRIETORlPARTNERlEXECUTIVE D EL EACH ACCIDENT 0
OFFJCERlMEMBER EXCLUDED? NI'
(Mandatory in NH) E.L DISEASE - EA EMPLOYEE $
g~st~r~~~ O~~PERATIONS below E.L DISEASE - POLICY LIMIT 0
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, If more space is requIred)
CERTIFICATE HOLDER
CANCELLATION
CASHLAN
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 AUTHORIZED REPRESENTATIVE
I C7!J(~ I
ACORD 25 (2009/09)
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