HomeMy WebLinkAboutInsurance Certificate: Welburn Electric Inc
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~R CERTIFICATE OF LIABILITY INSURANCE OPID KIY I DATE (MMIDDfYYYY)
12/21/10
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 HOLOER.
~NT: I, tne certlTicate hOloer IS an ADDIT,UNAL I ,tne POllcYlles) must be endorsed. If SUBROGATION 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:" Kendall Yeaw
Protectors Insurance, LLC r~~N~o, ExU: 541-773-5358 I lAiC. No). 541-772-190
Pilot Rock Ins Agency LLC (CA)
PO Box 4669 ~DMDA~~ss: kendallv@Drotectorsins.com
Medford OR 97501 CUSTOMER 10 #: WELBU-1
Phone:541-773-5358 Fax:S41-772-1906 INSURER(S) AFFORDING COVERAGE NAlc.
INSURED INSURER A : North Pacific Insurance
Walburn Electric Inc INSURER B :
PO Box 329
Phoenix OR 97535 INSURER C :
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~~~ TYPE OF INSURANCE INSR POLICY NUMBER (MMlDDfYYYY) (MMJOD;mv) LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
- C18127353 $100,000
A X COMMERCIAL GENERAL LIABILITY 12/23/10 12/23/11 PREMISES rEa occurrence)
I CLAIMS.MAOE ~ OCCUR MED EXP (Anyone person) $ 5,000
PERSONAL & ADV INJURY $1,000,000
- $2,000,000
- GENERAl AGGREGATE
~'L AGG~EnE LIMIT APnS PER: PRODUCTS - COMP/OP AGG $2,000,000
X POLICY ~:2-,: LOC $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000
- (Eaaccident)
A ~ ANY AUTO C18127353 12/23/10 12/23/11 BODILY INJURY (Per person) $
ALL OWNED AUTOS BODILY INJURY (Per accident) $
-
- SCHEDULED AUTOS PROPERTY DAMAGE
$
HIRED AUTOS (Peraccidenl)
- $
NON-OWNED AUTOS
- r ---
r::\ ~i.~ :;.- '\ lL .-:::--, ~I $
UMBRELLA LIAS H ~CCUR 1)1 " , / -. , I )11 EACH OCCURRENCE $
- EXCESS LIAB
CLAIMS-MADE AGGREGATE $
I
- DEDUCTIBLE DEe 2 9 2010 'I $
I
, I,
RETENTION $ , " $
WORKERS COMPENSATION " --) ::;1 ITOR/LIMITS livER'
AND EMPLOYERS' LIABILITY "N I - -- I
ANY PROPRIETORJPARTNERJEXECUTIVD E.L. EACH ACCIDENT $
OFFICERJMEMBER EXCLUDED? !.
(Mandatory in NH) L -- E.L. DISEASE - EA EMPLOYEE $
g~st~~~~~ OnFdOPERATIONS below E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITYAS2 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Ashland AUTHORIZED REPRESENTATIVE
20 E Main Str
Ashland OR 97520 R. Joe Hubbard
I
ACORD 2S (2009/09)
@19BB-2009ACORDCORPORATION. All rights reserved.
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