HomeMy WebLinkAboutInsurance Certificate: Wilma LLC
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ACORD- CERTlFICA TE OF LIABILITY INSURANCE I DATE (MMJDDIYYYY)
1....,....---. 1/14/2011
THIS CERTIFICATE IS ISSUED AS A MAlTER 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 BElWEEN THE ISSUING INSURER(SI, AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certlftcate holder Is an ADDiTlONAL INSURED, the pollcy(I..) 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 endorsemenUst
PRODUCER NAME: Susan Wilson, MI, AlC
Beecber carlson rnsurance Agency LLC l:IJg~o E"': (S41) 772 1111 I rAia No': (541)772-3785
707 Murphy lid i~~ss:susan.wilson@beechercarlson.com
~n~~~ID,POO58B44
Medford OR 97504 INSURER(SI AFFORDING COVERAGE NAle,
INSURED INSURERA American Hallmark Ins CO of TX 143494
INSURERS :Deve10DeJ:8 Surety & :Ind.emD.itv
Wilma, LLC INSURERC:
744 Helman street INSURER 0 ;
INSUR&R& :
Ashland OR 97520 INSURERF:
COVERAGES
CERTIFICATE NUMBER:CLl111497437
REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE L1STEO BELOW HAVE BEEN ISSUEO TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOO
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT Wm-t RESPECT TO W-tICH nilS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBEO 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 &~}J&"~ I ,&OUCY EXP UMITS
LTR POLICY NLNBER MMI
GENERAL LIABILITY EACH OCCURRENCE I ~,OOO,OOO
-
X COMMERCIAl... GENER.AJ... LIABILITY PREMISES Ea occurrence! I 100,000
A I CLAIMS-M.ADE ~ OCCUR 4CL45754302 /6/2011 11/6/2012 MED EX? (My one person) I 5,000
- PERSON/IL & I'DV IN..lJRY . 1,000,000
- GENERAl... AGGREGATE I 2,000,000
~~ AGG~EnE fllMIT APPnSIPER: PRODUCTS - COMPIOP AGG I 2,000,000
X POLICY Pf'p,: LOC I
AUTOMOBILE LIABILITY ~ ~ @ ~ 0 ill ~, COMBNED SINGLE LIMIT I
- (Eaeccident)
,..- .A.NY AUTO I BODILY INJURY (Per person) I
I- .AJ...L OV'YNED AUTOS R I'j 2 .011 I BODILY INJURY (Per accident) I
SCHEDULED AUTOS 0,-', ()
I- PROPERTY DAMAGE I
I- HIRED AUTOS (Per accident)
NON-O\o\NED AUTOS By I
I- -'__-'...J .
UMBRELLA LIAS H OCCUR EACH OCCURRENCE I
-
EXCESS L1AB CLAIMs.M.ADE AGGREGATE .
- nFf"lI.Jr:T1RlF I
RETENTION <t I
WORKERS COMPENSATION lAC STATU I01,t<.
AND EMPLOYERS' LIABILITY VIN
AN'( PROFRIETORIPARTNERIEXEQJTIVE D EL EACH ACCIDENT I
O~ICERJMEr..1l3ER EXCLUDED? NIA
(MandatorylnNH) EL DISEASE - EA EMPLOYEE $
g(S~grmo~ On~~PERATIONS below EL DISEASE POLICY LIMIT I
B CCB License Bond 99418C /6/2011 /6/2012 limit" $20,000
Residential Developer
OESCRlPTlON OF OPERATIONS I LOCATIONS I VEHICLES (AttDch ACORD 101, Additional Remarks Schedule, If more Ipace II required)
Certificate holder included as additional insured per attached endorsement CG20120798 where required by written
contract. Subject to policy terms, conditions and exclusions.
CERllFICATE HOLDER
CANCELLAllON
SHOULD ANY OF 111E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRA nON DAlE THEREOF, NonCE WILL BE DELIVERED IN
The City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS.
clo Richard Appichello city Attorney AUTHORIZED REPREi5ENTATIve
20 East Main street
Ash~and, OR 97520
~ ~ ::L-.
S Wilson, AAI, AlC/SU _.~ Il.!.L f-- .~.. .
ACORD 25 (2009/09)
IN5025 (200909)
@ 1988.2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
POLICY NUMBER:
COMMERCIAL GENERAL LIABILITY
CG20120798
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED -
STATE OR POLITICAL SUBDIVISIONS - PERMITS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
State Or Political Subdivision:
(If no entry appears above, infonnation required to complete this endorsement will be shown in the Declarations
as applicable to this endorsemenl.)
Section II - Who Is An Insured is amended to
include lIS "n insured "ny sl"le or politic...1 suhdivi-
sion shown in the Schedule, subject to the following
provisions:
1. This insurance applies only with respect to op-
erations performed by you or on your behalf for
which the state or political subdivision has issued
a penn it.
2. This insurance does not apply to:
a. "Bodily injury:' .property damage" or
"personal and advertising injury" arising out
of operations perfonned for the state or mu-
nicipality; or
b. "Bodily injury" or "property damage" included
within the "products-completed operations
hazard",
CG20120798
Copyright. Insurance Services Office, Inc., 1997
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