HomeMy WebLinkAboutInsurance Certificate: Pacific Powder Coating
ACORD'" CERTlF!CA TE OF LIABILITY !NSURANCE I DATE (MMIOOiVYVYI
~ 5/20/20H
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
REPRESENTATlVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDI110NAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
Iha terms and condillons of lha polley, certain ~_OIiClBS may raquirs:an endors8msnt. A statement on this certificate dOlls nol confer rights to the
certificate holder In lieu of such endorsement(s _
PRODUCER N~llk Susan Wilson, AAI, AlC
Beecher Carlson Insurance Agency LLC PHONE (541) 772-~1~~ I ffr~ No: <<541)172-3195
Ale No Ex .
707 Murphy Rd -f~~~-5S; susan. wilsonQheecherc.oI.rlson _ com
PRODUCER 000083$3
Medford OR 97504 INSURER(S) AFFORDINC COVERACE NAIC.
INSURED INSURER A American Hall.mark Ins Co of ~ 3494
INSURER B :
Pacific Powder Coating INSURER C :
p 0 Box 2370 INSURER 0:
INSURER E :
White city OR 97503 INSURERF'
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOlWlTHSTANDNG ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO w-llcH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO All THE TERMS.
EXCLUSIOOS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOIIvN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE POLlCYEFF POLlCVEXP LIMITS
el" POLICY NUMBER MMJOOIYVYY Io4NIDONYVY
CENERAL L1ABIUTV i:A<:H OC':'JRREN-':E , 1.,000,000
- -N 300,000
~~AMFPr:IAI (;FNF~I.c.RIIIT'I P;:!.~M\SES iEa O<X'..lT9nc<!' ,
... __I ClAIM5-MAOE ~ O.X..!" 4CL41.271.309 {3/2011 {3{2012 MEa EX:> tAllY CI"-' p6rwll) . 5,000
- rERSONf..L & .a.r.>v IN,lJrl'l' , 1,000,000
- GENEH"-l AC.;GPEGJ..TE , 2,000,000
~'~ AG(;~EnE LIMIT APn'"' PER :JROOUCT5 _COMP;O:J ,l,GG , 2,000,000
X POL C'r' PJI.,9.,: LOC ,
AUTOMOBILE LIABIUTY COfllBI'IlED SlN[,LE LIMIT , 1,000,000
- /i:flill>.::id>'llIt/
- PoN'l ALlTe BODeI' IN,IUFiY(Pill J'H,.{]Il) $
... K..LO...-v-lE:D..o..uTQ!,; 4CL41271309 /3/2011 /3/2012
X BOOL Y IN,IUf'Y (pgr IlCcidenl) ,
SCHEDULED AUTOS
- PR:lPERTY DAMAGE ,
- HII1ED ';UTCS \'?~r",n'i,j.;w'tl
- NOf~-Ov.NE[l AUTQS PIP-Basi; , l5,OOO
M.>:ticalpayrmnls S 5,000
Lt.4BRELLA LlAB H:)CCJP. E....CH O~CU"RE'lCE ,
- EXCESS LIAB
CL-"I\IlS.J\~fI(JE A:;(;REGPTE ,
- CEDUCTIElE ,
nETENTION , ,
WORKERS COMPENSATION T~~~T~J,~" I \C~~_
AND EMPLOYERS. LIABILITY Y I N
ANY PR;:;JPP',E70R!?4R7t.EQIEXEGJTlVE 0 NI. 5.L. EP.Ch ACCIDENT ,
OFFICFRIMFWRFR FXr/ IlnFm
(MlndmorylnNH) :,L_ JIf;EASE - EP. EMPL::J'"E=. $
If)"'~. de""-I1l>~ '/nthr =.L DISEASE POLl:\,UVIT ,
DESCRIPTtOf>.. CF OPEJ:;!ATIOt-lS Oglow
OESCRlPTlON OF OPERATIONS I LOCATION,. IVEI-IICLES (Attlch ACORD 101, Addltlon.1 R-m.h Schedule, lfmo.e .p.ct I, .e.,"dred)
Th. City of AlOhl.Ol-fld, OrClqon and itlO ' Bl.ected oEficialJ;, officorlO " Clmployc;II;a1O or. Ol-dditional inlOurClds on any in6urancB
policies rClqui r~ hClrein but only with rQJ;pClct;- to ContrOl-ctor'i: lI;orvicQIO to b. providCld umkar thilO contrOl-ct p.r
Ol-ttOl-ched endorlOgment CG3261100S wheril requirC;Jd by written contract. Thill; inlOurOl-ncQ 10 prifl'lOlry . non-contributory.
Subject to poI.icy termll", conditionll" and BXcI.uGionll".
Beecher Carlson
5/20/2011 3:38:11 PM
.~
COVERAGES
CERTIFICATE NUMBERoCLl152002294
CERTlRCATE HOLDER
(541)488-5320
City of Ashland
Attn: Kari 01son, Purchasing Representati
90 N Mountain Avenue
Ashland, OR 97520
PAGE
1/001
Fax Server
REVISION NUMBER'
CANCELLATION
SHOUL.D ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEL.LED BEFORE
THE EXPIRATION DATE THEREOF, NOT1CE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUiHORfZED REPR~ENTA TlVE
"".- ---... ,(;
S Wilson, MI, AlC/SU <=.~ ,..".:). .J.1..,,~.
@ 19S8~20Q9 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered mafks of ACORD
F-cJ -# / cP ~ '1.:2-
ACORD 25 (2009/09)
INSQ25(~oo9ogl
Beecher Carlson
5/20/2011 3:50:58 PM PAGE
1/001
Fax Server
.,
POLICY NUMBER:
COMMERCIALGENERAL LIABILITY
CG 32611005
THIS ENPORSEMENTCHANGES 11-IE POLICY. PLEASE READ IT CAREFULLY.
OREGON ADDITIONAL INSURED - OWNERS,
LESSEES OR CONTRACTORS - SCHEDULED PERSON
OR ORGANIZA liON
This. endorsement modifies insurance provided under the following:
COMMERCI.A.L GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person!s) Or Organization.!s):
City of Ashland, Oregon and its' eJected offidcals, officers & employees
90 N Mountain A"enue
Ashland, OR 97520
Location(slOf Covered Operations:
All projects of named insured
Information reaulred to comolete' this -Schedule, if not shown above, will be shOlNn!n the Declarations.
A. Section 11 - Who '1s An Insured is amended to
Include ~s. an addltjonal insured the persori(s) or
organlzation(s) shown in the Schedule, but only
with respect to liability for "bodily injury", "property
damag_e\O or "personal and advertisIng injury"
caused by your' ongoih!;;f operations for the addf-
tional Insured(s) at the looation($) designated
above and only to the extent that such "bodlly in-
jury", "property:qa_magell or "personal and'advertis---.-"
ing inJulY" is caused by your n~gllgence or the neg~
Jigence of .those performing operations-en your
behalt .
B.With _ reSpect.to the insurance afforded .\0 these
additiona!" insureds, the follovving additional exctu-
sian applies:
This insurance does not apply to "bodily injury" or
lIproperty da'mage" .accuning after:
1. Ail work, including materials, parts or equip-
ment furnished In connection 'hitl1 such work,
onttie..project (other'than service, maint.enance
or repairs) to be performed by or on behalf of
the additional insured(s) a! the location of the
covered operations has been completed; or
2. That portion of "your work" out of whicl1 the
injury or damage arises' ha~ been p'ut to its in-
tended use by 'any- person or organization other
than another contractor or sUbcontraotor. en-
gaged In performing operations for a principal
asa part 01 the same project,
CG 3.26110 05
@ISOProperties, Inc., 2005
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