HomeMy WebLinkAboutInsurance Certificate: Marquess & Associates (2)
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~R CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIODIYYYY)
OP 10 SAW ~/: II:
12 30 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: IT the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the tenns 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 I NAMEC'" ,
Protectors Insurance, LLC I r.i}gNtfo Ext\: I r~,NO):
Pilot Roek Ins Agency LLC (CA)
PO Box 4669 I ~~DA~~SS:
Medford OR 97501 CUSTOMER 10 #: MARQU 1
Phone: 541-773-5358 Fax:541-772-1906 INSURER(S) AFFORDING COVERAGE NAIC#
INSURED INSURER A : SAIF Corporation
Mar~ess & Associates Ine \ INSURER B :
PO ox 490
Medford OR 97501 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.
'~f~ TYPE OF INSURANCE ~s':: I~~ POLICY NUMBER (M~][\5~) (MM/DDIYYYY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
c-
COMMERCIAL GENERAL LIABILITY I PREMISES (Eaoccurrence) $
I CLAIMS-MADE D OCCUR MED EXP (Anyone person) $
PERSONAL & ADV INJURY $
- f :~\I
,...,':-\. 1-'-- GENERAL AGGREGATE $
'-- ii' ' .. - " \\1{ !.--
~'L AGG~EnE LIMIT APnS PER: ~ PRODUCTS - COMP/OP AGG $
POLICY j~gT LOC '.Ii ! ,I $
AUTOMOBILE LIABILITY - , ~i COMBINED SINGLE LIMIT $
- I J.~N - 4,';;>011 (Eaaccident)
ANY AUTO I i
- J l' BODILY INJURY {Per person} $
ALL OWNED AUTOS ..
- l I J J BODILY INJURY (Per accident) $
- SCHEDULED AUTOS PROPERTY DAMAGE
HIRED AUTOS (Per accident) $
c-
NON-OWNED AUTOS $
c- $
UMBRELLA LIAB H OCCUR EACH OCCURRENCE $
c- EXCESS LIAB
CLAIMS-MADE AGGREGATE ,
---- -
- DEDUCTIBLE $
RETENTION $ $
A WORKERS COMPENSATION "'~,jl~" 01(01(11 01(01(12 I TOR/LIMITS I IUER I
AND EMPLOYERS' LIABILITY "N
ANY PROPRIETORlPARTNERlEXECUTIVD E.L. EACH ACCIDENT ,1000000
OFFICER/MEMBER EXCLUDED? fA
(Mandatory in NH) E,L. DISEASE - EA EMPLOYEE ,1000000
g~S(;~iPiI"8N oi=dOPERATIONS below E.L. DISEASE - POLICY LIMIT ,1000000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLEi (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
STREET IMPROVEMENT PROJECT 2005-34
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 Street /1!!lfixr
Ashland OR 97520 /J
!
ACORD 2S (2009/09)
@1988-2009ACORD CORPORATION. All rlghls reserved.
The ACORD name an~ 10SJo a~ re:gis~ered marks of ACORD