HomeMy WebLinkAboutInsurance Certificate: Rogue Valley Electric
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~R CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDJYYYY)
OP ID DS 01/04/n
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: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. if SUBROGATION IS 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:
Insurance Marketplace, Inc. r~g.NJo, Ext': Ir~.No)'
1998 Skypark Dr Suite 100 iirtRESS:
Medford OR 97504 1> ROGUE10
CUSTOMER 10 #:
Phone:54l-779-0l77 Fax: FAX 772-8235 INSURER(S) AFFORDING COVERAGE NAICfI.
INSURED INSURER A : American States Ins. Co. 19704
Rogue Valley Electric, LLC INSURER B :
Steven W Rouse
PO Box 475 INSURER C :
Phoenix OR 97535 INSURER 0 :
INSURER E :
INSURER F : .cc
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.
LTFt TYPE OF INSURANCE INSR WVD POLICY NUMBER (~~Mg7v~) (M~g~) LIMITS
GENERAL LIABILITY EACH OCCURRENCE .1,000,000
A X COMMERCIAL GENERAL LIABILITY 01-CI-325445-2 02/10/11 02/10/12 PREMISES E~~~~~~nce) .200,000
I CLAIMS-MADE ~ OCCUR MED EXP (Anyone person) .10,000
X PERSONAl & ADV INJURY .1,000,000
GENERAL AGGREGATE .2,000,000
~~ AGG~EnEILlMIT APrlS PER: PRODUCTS-COM~OPAGG .2,000,000
POLICY ~~8i LOC .
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT .
- (Eaaccident)
- ANY AUTO BODILY INJURY (Per person) .
ALL OWNED AUTOS BODILY INJURY (Per accident) .
-
- SCHEDULED AUTOS PROPERTY DAMAGE
.
HIRED AUTOS (Per accident)
- .
NON-QWNED AUTOS
- .
UMBRELLA L1AB H OCCUR EACH OCCURRENCE .
- EXCESS LIAB
CLAIMS-MADE AGGREGATE .
- DEDUCTIBLE .
RETENTION . .
WORKERS COMPENSATION. . , ITORiLII~lfls I IVER-
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVD ~IA E.L. EACH ACCIDENT .
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE
(Mandatory in NH) .
~~~~~f~i~~ OnFdgpERATIONS below E.L. DISEASE - POLICY LIMIT .
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
Certificate holder is additional insured per the attached CG7635 02/07
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
ASHLAND THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Ashland All Officers
and Employees AUTHORIZED REPRESENTATIVE
90 N MOWltain Ave
Ashland OR 97520
I
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ACORD 25 (2009109)
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