HomeMy WebLinkAboutInsurance Certificate: Pape Machinery Inc
~
A;,CORD" CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDNVYY)
02125/2011
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: II the certilicate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. II SUBROGATION IS WAIVEP, 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 endorsementCs\.
PRODUCER CONTACT
MARSH USA INC. NAME:
111 SW. COLUMBIA PHONE Ir~ No':
FIFTH FLOOR E-MAIL
PORTlAND, OR 97201 ADDRESS:
PRODUCER
Attn: Uz Whiting 503-248-1204
90081 O-D5-CAS~ 11 ~ 12 PM INSURER/51 AFFORDING COVERAGE HAle_
INSURED INSURER A: National Union Fire Ins Co Pittsburgh PA 19445
PAPE' MACHINERY. INC. INSURER 8 : N/A N/A
C/O THE PAPE' GROUP
PO BOX 407 INSURER C : N/A N/A
EUGENE. OR 97440 INSURER 0 :
INSURER E :
INSURER F :
COVERAGES
CERTIFICATE NUMBER'
SEA-OOI796841 ~29
REVISION NUMBER' 1
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABDVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REOUIREMENT, 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 A.~2.,L I~~~' POLICY EFF POLlCY EXP LIMITS
LT' POLlCY NUMBER MMlDDIVYYY MMfDDlYYYY
GENERAl LIABILITY EACH OCCURRENCE . 1,000,000
A I-c-;- GL 4309767 0310112011 0310112012 ~~C~~J9~~~~ence\ 250,000
X COMMERCIAL GENERAL LIABILITY .
1 CLAIMS-MADE 0 OCCUR MED EXP (Anyone person) . 25,000
X CONTRACTUAL LIAB. PERSONAL & ADV INJURY . 1.000,000
f-x PER LOC AGG 12M GENERAL AGGREGATE . 10,000,000
- 2,000,000
-Yl'L AGGRnE LIMIT APnS PER: PRODUCTS.COMP~PAGG .
X POLICY ~~RT LOC .
A AUTOMOBILE LIABILITY CA 3462063 03101/2011 0310112012 COMBINED SINGLE LIMIT . 1,000,000
X (Eaaccidenl)
- ANY AUTO BODILY INJURY (Per person) .
C- ALL OWNED AUTOS BODILY INJURY (Per accident) .
f-x SCHEDULED AUTOS PROPERTY DAMAGE
HIRED AUTOS (Peraccidenl) .
f-x NON-OWNED AUTOS .
-
.
UMBRELLA L1AB H ~CCUR EACH OCCURRENCE .
-
EXCESS L1AB CLAIMS-MADE AGGREGATE .
- DEDUCTIBLE .
RETENTION . .
WORKERS COMPENSATION I we STATU~ I 10J~~
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNERlEXECUTIVE D EL EACH ACCIDENT .
OFFICER/MEMBER EXCLUDED? NIA
(Mandatory in NH) EL DISEASE - EA EMPLOYEE $
~~~~~f~ir~ ~~~PERAT!ONS below EL DISEASE - POLICY LIMIT .
DESCRIPTION OF OPERATIONS I LOCATIONS J VEHICLES (Attach ACORD 101, Addltlonal Remarks Schedule, If more space Is required)
RE: THE CITY OF ASHLAND, OREGON, AND ITS ELECTED OFFIOALS, OFFICERS AND EMPLOYEES ARE INCLUDED AS ADDITIONAL INSUREDS WHEN REQUIRED BY WRITTEN AGREEMENT OR CONTRACT
AS RESPECTS TO OPERATIONS OF THE NAMED INSURED,
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY DF THE ABOVE DESCRIBED PDLlCIES BE CANCELLED BEFORE
CITY OF ASHLAND THE EXPIRATION DATE THEREDF, NOTICE WILL BE DELIVERED IN
20 EAST MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS.
ASHlAND. OR 97520
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
I Elizabeth A. Whiting ~"" II.Whi/onr
ACORD 25 (2009109)
@ 1988-2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks 01 ACORD