The URL can be used to link to this page

Home My WebLink AboutInsurance Certificate: RW Hays Co Inc JUN-20-2011 13:29 ELLIOTT POWELL BADEN BAKE 5032747644 P.01 ~,. ACORD"" CERTIFICATE OF LIABILITY INSURANCE I DAT& IMWDD/'r'Y'n') "---"" 6/17/2011 THIS CERTIFICATE IS ISSUED AS A MIoTTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTlFI(;ATE obES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOw:' THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BElWEEN THE ISSUING INSURER(S). AUTHORIZED REPRESENTATIVE OR PRODUCER.IoND THE CERTIfiCATE HOLDER, IMPORTANT: If tho cortJllc;alo holdor Is on .DDITlONAL INSURED. Ihe policy(ies) must be endo",.d. If SUBROGATION IS WAIVED. subjecllo the tenns and condJtions of tha policy, certain policies may require an endorsement A statement on this certificata doGS not confer rights to the certificate holder in lieu of such endorsement{s). PRCDUCSR NAME: Pam Wimmer Elliott powell Baden and Baker Inc. ~J;Ert" (503)227-1771 f r~~ (so~.~!._!~:?~~~...._ 1521 S.W. Salmon Street ~.pwimmar@Bpbb. c""" PRo ~,".00004902 Portland OR 97205-1783 INSUReRtSI ;;"RDINGI COVERACif: HAle", INSUREO IN&URERA :Ccntinenta.1 Weste.1:n Insuranc.e IMeURER 8 : ._.-.~ -,-~-- RW Hays Co Inc, DBA: Hays Oil Company J}!SURER C l..._......_ BiMOr Stations Inc INsuRe~ CI : PO Box 1220 ".....-..-~--- INSlJRER E : Medford OR 97501 .._~~ IN&UR&R F : COVERAGES CERTlACATENUMBI'R:11-12 GL, Anto, UIeb REVISION NUMBER: TIllS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NO'MlTHSTANDING ANY REQUIReMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT ~TIi RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDE;D BY THE POLICIES OESCR.IBED HEREIN IS SUBJECT TO ALL THE rERMS, EXCLUSIONS AND CONDITIONS OF SUCH =~' LIMITS SHOlMl MAY HAVE BEEN REDtii~t ~S, l~.f: TYP~ OJ! INSUR.&NC~ POUCY NUMBER MMi~ MllAtO P -....'............_- LIMITS G~NERAL UABIUTY I!.A.CH oeCURR5NCr;: , 1,000,000 r-- "'O~ X COMMeRCIAL GENERAL UABlWTY ~R!:l'.l'~~~ ~ L.. . 100.000 A :...J CL./IJMS-MA.OE [iJ OCCUFi r=oP2S13803; 11/2011 1112012 MED EXP (Anv one personl . 5.000 f--. 1,000,000 f- PERSONAL & AD'll INJURY , f-- _~_.~'r............................. GENERAL AGGREGATE , 2,000,000 1ilN\. AGG~nCILIMIT APn~ PER: .~I?~~:S:9MProP ....GG , 2,000,000 X POLICY ~~ lOC 5 AUTOMOSILE L1ABIUTY COMBINED SINGLE UMIT 5 1,000,000 r-- (Eaatr:ident) ~ ANY AurO ....-~_.....- -- (,;DJ;l29'38Q;ag 11/2011 17(1(2012 BODILY INJURY (pel' p!lrWl"l) , A f-" ALl O\MIIED AUTOS 60DIL Y INJURY (per accidllnl) .$ r-- SCHEDULED AlJTOS PROPERTY DAMAGE , r-- HIRED AUTOS (Per KC'denl) NON.o~ AUTOS Unhal.lnK:J motoriat ccmbined 5 I-'- PlP-Baslc . UM8ReLL.A lIAB M OCCUR EACH OCOJRRENCE 5 10,000.000 r-- .~-_. X EXCESS lIAB ClAIMS-MACe AGGREGAT~_.._..~_c._~_ . 10,000,000 OECucnSI.E ---,-...~-.-...._..- --.- s r-- =..OQ40 /1/2(111 1112012 A R,l!T!iiNTION , NIL . WORI'CERS QaMP'liH5ATlON _~dTfJ,~i;:! IOl~' AND E"PLO~ UASlUTY YI" ANY P~RIETORJPARTNE1ilIEXEClIT'1VE 0 MIA EL EACH ACCIDENT . .~,~~~~- OFFlOER/MEMBER EXCLUDSC? ~nd.ry In NH) ~,L DISEASE. EA EMPLOYE! , g~~O~'t,~PE~TIOf.lS biJklw E.L D1$E.t.$E . POUCY UMIT I $ DESCRIPTION OF iOP~A.ATlONS Il.CCA.TlONS' veHlCl.es (JUtI~ A.CORD 1D1, AddlUQf\ld Rerntrtw Schl;Cb.llo;lr"",~ ~c: Is rDCtwrcd) R4= p.1~v.ry Of Fuo~, ~o C~t~ oE ~shlAn41 C~Qgon And its Elocto4 Official~, O~~LCO.B .n~ EmplgyeQs 8.e included as Additional Insureds per ~orms CW 3130 (09 06) and. CW lO54L (01 '0) ,,"ce~eb.ed.. This In~urane8 i~ P.1m4:y and Non-Co~t~1~ucory. SUbject to policy to~, con41tiona and OXClu3ions. CERTIFICATE HOLDER CANCELLATION (541)488-5320 SHOULI) ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLEO eEFORE THe EXPIRATION DATE THEReOP, NOTICE WILL BE OEUVERED IN City of Ashland ACCORDANce WITH THE POLICY P~OVJSIONS, Issued by Federated AUTHORIZED REPRESENTAnvE 90 N Mountain Ave Ash1.and, OR 97520 Pam Wimtller In ~~ eX' c.U~ ACORD 25 (2009109) INS025 _I @1988.2009ACOROCORPORATION. loll rights ,"served, Tho ACORD name and logo are registered marks or ACORD JUN-20-2011 13:30 ELLIOTT POWELL BADEN BAKE 5032747644 P.03 ,\ , POWCY NUMBER: ~KIS EHDORSBMEH~ CHARGES mE POLICY. PLEASE READ IT CAREFULLY MANUSCRIPT EHDORSEMEBT This ~ndorsement modifie~ insuranc~ provided unde= th@ followins: o COMMERCIAL PROPERTY COVERAGE PART o BOSIN8SS0WNERS o INLAND MARINE o CRIME COVERAGE PAR! o COMMERCIAL AUTO COVERAGE PART ~ COMMERCIAL GENERAL LIABILITY COVERAGE PART o PRODUCTS COMPLETED OPERATIONS LIABILITY COVERAGE PART DOWNERS AlID COl'JTRACTORS PROTECTIVE LIABILITY COVERAGE PART D COMMERCIAL llMllRE~LA POLICY D WORKERS'cOMVENSATION POLICY ADDITIONAL INSORED - PRIMARY COVERAGE ~ SCHEDULEO PERSON OR ORGANIZATION (continu~d) ***~*+7*.*****+~*.+W~*******~~.W~~***.***~~*******+******~**+*.**+**~* Name of Addi~ional Insu~ed Person(3) Or Or9aniz~tion(~) ~ Any pp.reon or Or9anization whom you are required to name ag an ~dciticnal in~ured on thi~ policy under a w~itten contr~ct or agreement. Such Iolritten contract or a.greement mus.t be eXQcut.ed prior to the "bQdily injury" or "property damage". No such per:aon or organization is an. ins';1r2d with resp€:ct t-.o any OCc~rence that take~ plac~ ~fter exp~r8~~on of the wr~tten contract or aqr~ement bl:!twl:!en you d.l"Jd sur:h pex:sofl or organiz..:.tion. ell 10 54 01 90 TOTAL P.03 JUN-20-2011 13:29 ELLIOTT POWELL BADEN BAKE 5032747644 P.02 .'., .' THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CW 313009 06 ADDITIONAL INSURED - PRIMARY COVERAGE - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEOULE Name Of Additional Insured PersonC51 Or OraanizationCsl; Bianket Additional Insured per form CW3130 and CW1 054L c/o RW Hays Co Inc PO BOX 1220 Medford, OR 97501 Location(s) Of Covered Operations: Information required to complete this Schedule. if not shown above, will be shown in the Declarations, A. Section 11- 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: 1. Your acts or omissions; or 2. The acts or om issions of those aoting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above, B. With respect to the insurance afforded to these additional insureds, the following additional exclusions appiy: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materiais, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of .your work" out of which the injury or damage arises has been put to irs intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principai as a part of the same project. C. Wilh respect to the Insurance afforded to these additional insureds, the following applies: . The insurance provided by this endorsement is primary insurance and we will not seek contrib,uUon . uQder any insuran,ce polioy under which such additional insured is a named insured, if such policy was procured and paid for by such additionai insured, or a parent or related entity of such additional Insured,