HomeMy WebLinkAboutInsurance Certificate: Peck Smiley Ettlin Architects
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~c2J1Rd .. CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDfYYYY)
~ 02/15/2011
TI-:IS 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 pollcy(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 801384 1 503-274-6511 ~~~~CT ..
Fullerton , Company .~- .. '. .., .._t.,',.:.";.lC; ..
Insurance .... -;.' !'~ . . p.~r>~~_ "_~'. . .. - " If~NO\: ..
PO Box 29018 E-MAil.
. ... ADDRESS:
.. \ ~. PRODUCER
, .-
Portland, OR 97296-0018 INSURER'SI AFFORDING COVERAGE
HAle .
INSURED INSURER A: HARTFORD CAS INS CO 29424
Peck Smiley Ettlin Architects INSURER B : The Emnlovers Fire
4412 SW Corbett Avenue INSURER C : SAIF Co~oration
Portland, OR 97239-4207 INSURER D: NEW HAMPSHIRE INS CO 23841
INSURER E :
INSURER F :
COVERAGES
CERTIFICATE NUMBER' 19758594
REVISION NUMBER'
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE liSTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POlley 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.
INSR TYPE OF INSURANCE ~.?= ~~~! &3MW~ ,&~~%~
LTR POLICY NUMBER LIMITS
A ~NERAL LIABILITY 52SBAUL 7992 04/01/1li 04/01/12 EACH OCCURRENCE $ 2000000
X COMMERCIAL GENERAL LIABILITY ~~~~~~ 9E~~~~~n~ $ 300000
I CLAIMs..MADE 0 OCCUR MED EXP (Any one person) $ 10000
"- PERSONAL & ADV INJURY $ 2000000
"- GENERAl AGGREGATE $ 4000000
ril'L AGC?REGATE LIMIT APnS PER: I ...., . ......- .~. .., .' .. PRODUCTS - COMP/OP AGG $' 4000000
,~~ X POLlCy,n 1;'~2.; LOC
.- , .. .. . <- .
B ~TOMOS1LE UABIUTY I 1E06005 . ~ -- - .05/09/1005/09/11 'COMBINED SINGLE L1MIT-' $ 1000000
(Eaaccidenl)
~ Am AUTO B~DIL Y INJURY (fer P.8~n) .
.' ,',. .., :'w', ;:.(;; ~ /,1\
I- ALL OWNED AUTOS , ", B,ODIL Y INJI;l_~Y (p.er accld~!'1.t) .
" ,. .' n '" :Y.: " .i
I- SCHEDULED AUTOS , . PROPERTY DAMAGE, ..
.. j,., .
I- HIRED AUTOS (Per accident) .' '-
I- NON-OWNED AUTOS .
.
I- UMBRELLA LIAS H OCCUR EACH OCCURRENCE .
EXCESS LIAS CLAIMs-MADE AGGREGATE .
I- DEDUCTIBLE .
RETENTION . .
C WORKERS COMPENSATION 978205 09/01/11 09/01/11 X I WC STATU-~ I IOJ.!!-
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETORlPARTNERlEXECUTlVE [!] E.L EACH ACCIDENT $ 500000
OFFICERlMEMBER EXCLUDED? Y NI'
{Mltn'.:!at~r,.,j",NI-l} i E.L. DISEASE - EA EMPLOYE. $ 500000
I:f~s.deseribeunder $.500000
D SCRIPTION OF OPERATIONS below EL DISEASE - POLICY LIMIT
D IProfess.1.onal 1 1 Y ANE1182259 1"<1"'1" I Per ~.1.a3.ID.
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, AddItional Ramarks Schadule, If more 'pace I, required)
Certificate holder is additional insured per policy form.
~ '=CORDER
CERTIFICATE HOLDER
CANCELLATION
Ci ty of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CMJCElLED BEFORE
THE EXPIRA liON DATE THEREOF, NOTICE Will "E DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
90 North Mountain Ave
AUTHORIZED REPRESENTATIVE
Ashland, OR 97520 ~'::hU-~
, USA
kletourneau
ACORD 25 (2009/09)
19758594
@ 1988-2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
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.
.
COMMERCIAL GENERAL LIABILITY
CG 20 26 07 04
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PLEASE READ IT,CAREF,ULLY ,"L "'0
. ... . -~}i THIS ENDORSEMENT CHANGES" THE POLICY.
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ADDITIONAl:. INSURED - DESIGNATED
PERSON OR ORGANIZATION
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This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organlzatlon(s)
~.' ',. .~, . . !
Information required to complete. t~is Schedule, if not shown abo~e., will..be.shown' in.the.Declarations''':....': .
Sectlon'lI '-Who Is An Insured is amended to
include as' an additional insured the person(s) or
organization(s) shown in the Schedule, but only with
respect to liability for "bodiiy injury", "property
damage" or "personal and advertising injury" caused,
in whole or in part, by your acts or omissions or tho
acts or omissions of those acting on your behalf:
A. In the performance of your ongoing operations;
or
.:::- ,.tl~.:..
t......;". '
B. In connection with your premises owned by or
rented to you. .. .
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f> ISO Properties. Inc., 2004
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