HomeMy WebLinkAboutInsurance Certificate: BB&A Environmental
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Ae;!--Rd CERTIFICA TE OF LIABILITY INSURANCE I ;;;;~~O:';YYJ
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 conditionsofthe policy; certain policies may require an endorsement. A statement on this certificide.does.not confer rights lathe",
certificate holder in lieu.of such endorsement(s)~ .- ~ - . - -". . - .:..'
PRODUCER .J.;....". ., : ~2~t~T Kr.;s Sutherl.and . -:. .. ., --.~,
Ward Insurance Agency' I rl'~N~, =....,. (541) 687-1117 ,- I ,F~~ No': (5U)342-8280.. - .
P O. Box 10167 ~m~~ss:kris@wardinsurance.net -',-
.. .. ~~l,?~~~~ 1",...00006278
EUQ'ene OR 97440
INSURED
Bergeson-Boese & Associates lnc
DBA: BB&A Environmental
32986 Roberts Court
Coburg
COVERAGES
OR 97408
INSURER(S) AFFORDING COVERAGE
INSURER A :Endurance American S~cial tv
INSURER B :Na tionwide Mutual Ins Comnanv
INSURER C :
INSURER D:
INSURER E:
INSURER F:
NAIC#
?37B7
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOlWITHSTANDING ANY REQUIREMENT, TERM OR CONOITION OF ANY CONTRACT OR OTHER DOCUMENT VV1TH RESPECT TO VVHICH THIS
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 ' ,~~&\WYl POLICY EXP LIMITS
LT" IN POLICY NUMBER MM/OO/YVYY
.GENERAL. LIABILITY EACH OCCURRENCE i. 1,000iOOO
f--'
~ COMMERCIAL..GENERAL. LIABILITY ~~'!"'''''. .. 50,000
" ,. PREMISES rEa occurrence)
A _I C~MSMAOE [i] OC~UR ~CC101007042 - .4/30/2011 4/30/2012 MED EXP (Anyone person) .. .- 5,000
I-'--
I-:-;-: .. " ., PERSONAC&ADVINJURY~ . 1,000',000
" " ... - " '., ~ " j, ., GENERAl~AGGREGATE"- ~ " s.. 2,0~0;000
- PRQOUCTS . CoMPfOP AGG ' 2,000,000
~L AGG~nE FLlMIT .AP~~t PER: .
POL1CY ~~g:. LOC .
AUTOMOBILE LIABILITY COMBINEO SINGLE LIMIT . 1,000,000
;::- (Eaaccident)
~ ANY AUTO ACP7571541172 /30/2011 4/30/2012 BOOIL Y INJURY (Per person) .
B - ALL OWNED AUTOS BODIL. Y INJURY (Per accident) .
X SCHEDULED AUTOS PROPERTY DAMAGE
.
HIRED AUTOS (Per accident}
X NON.OVv'NED AUTOS Uninsured motorist oombined .
f- i'
PIP.Basic
UMBRELLA LIAS M ~CCUR EACH OCCURRENCE . 1,000,000
f-- EXCESS LIAS i. 1,000,000
X CLAIMS MADE AGGREGATE
- DEuUCTI61.E .
A RETENTION . EXSI01007043 /30/2011 4/30/2012 .
WORKERS COMPENSATION IT~.mJ,~~1 IOJ!;,'
AND EMPLOYERS' LIABILITY VIN
ANY PROPRIETORII'ARTNER/exECUTIVE 0 E.L. EACH ACCIDENT ,
OFFICER/MEMBER EXCLUDED? N/. EL DISEASE. EA EMPLOYFF $
(Mandatory!" NH)
~~~~~r6~ ~~~PERATIONS below E.L. DISEASE - POLICY LIMIT ,
A POLLUTION LIABILITY e:CCI01007042 /30/2011 /30/2012 LIMIT $1.,000,000
PROFESSIONAL LIABILITY LIMIT $1,000,000
DESCRIPTION OF OPERATIONS f LOCATIONS f VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
THE CITY OF ASHLAND, ITS OFFICERS, EMPLOYEES AND AGENTS ARE ADDED AS ADDITIONAL INSUREDS IF REQUIRED BY WRITTEN
CONTRACT
CERTIFICATE NUMBER:ll/12 GL/AU/UM/POLL/PROF
REVISION NUMBER:
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRA nON OATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
CITY OF ASHLAND
20 E MAIN STREET
ASHLAND, OR 97520 AUTHORIZED REPRESENTATIVE
Rob Harvey/KRIS ~.&....ot d'.f2'lb~
=.--,
ACORD 25 (2009/09)
INS025 (200909)
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