HomeMy WebLinkAboutInsurance Certificate: Public Works Mgmt
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OP 10: TP
ACORD" CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDIYYYV)
~ 06/29/11
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 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 541-245-1111 ~~~~~CT Therese Pritchett
United Risk Solutions. Inc. 541-245-1112 ~.18~_,541-494-7744 I f~ No', 541-245-1112
PO Box 936
Medford, OR 97501-0067 ~o"b~~ss: therese.pritchett(ci)unitedrisk.com
Workers Camp House Account _~ng~~~~: ID ,,: PUBL01W
INSURER(S) AFFORDING COVERAGE NAlCfI
INSURED Public Works Management, Inc. INSURER A SAIF Corporation
60 North 4th St INSURER B :
Central Point, OR 97502 INSURER C :
INSURER 0 :
INSURER E :
INSURER F :
COVERAGES
CERTIFICATE NUMBER:
REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY 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 POLICY EFF I~OLlCY EXP LIMITS
LTR I POLICY NUMBER MMfDDNYVY MMIDDNYVY
GENERAL LIABILITY EACH OCCURRENCE $
I-
COMMERCIAL GENERAL LIABILITY PREMISES /E~~~nce) $
I CLAIMS-MADE D OCCUR MED EXP (Anyone person) $
I- PERSONAL & ADV INJURY $
I- GENERAL AGGREGATE $
nL AGG~EnE,L1MIT APnS PER: f\ ~~~O~~ PRODUCTS-COMP~PAGG $
POLICY ~~p,: LOG $
AUTOMOBILE LIABILITY .LI COMBINED SINGLE LIMIT $
- (Eaaccident)
,- ANY AUTO JUL - 1 2011 BODILY INJURY (Per person) $
C- ALL OWNED AUTOS ~I BODILY INJURY (Per accident) $
c- SCHEDULED AUTOS PROPERTY DAMAGE
$
c- HIRED AUTOS (Per accident)
NON-QWNED AUTOS $
C-
$
UMBRELLA LIAB H ~CUR EACH OCCURRENCE $
- -
EXCESS L1AB CLAIMS-MADE AGGREGATE $
f-- DEOUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION X I T~~$'mJN~ I IOJ~'
AND EMPLOYERS' LIABILITY
A YIN 967233 07/01/11 07/01/12 500,000
ANY PROPRIETORlPARTNERlEXECUTrvE [!] E.L EACH ACCIDENT $
OFFICERJMEMBER EXCLUDED? NIA
(MlIndatorylnNH) E.L DISEASE - EA EMPLOYE $ 500,000
g~~~rtfr8~ ~~~PERATIONS below E.L DISEASE - POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES ~ttach ACORD 101, AddItional Remarks Schedule, If more space Is required)
ALL OPERATIONS OF THE NAMED INSUR 0
JOE STRAHL, PRS - EXCLUDED
CERTIFICATE HOLDER
CANCELLATION
CIT AS03
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
20 E Main Street ACCORDANCE WITH THE POLICY PROVISIONS.
Ashland, OR 97520
AUTHORIZED REPRESENTATIVE
I ~~ elctlJ
ACORD 25 (2009/09)
@1988-2009ACORD CORPORATION. All ri9hts r.served.
The ACORD name and logo are registered marks of ACORD