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Home My WebLink AboutInsurance Certificate: RW Hays (2) JUN-20-2011 13:29 ELLIOTT POWELL HRDEN HRKE 5032747644 P.01 AC<;?"7 ' CERTIFICATE OF LIABILITY INSURANCE 6 17/22011 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 certlflcato holder Is an ADDITIONAL INSURED,the Poifry(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 dose not confer rights to the certificate holder in lieu of such endomement(s). PRODUCER NAME: Pam m. Elliott Powell Haden and Baker Inc. PRONE �� i'1lrAlfe,-[{lQ_I`'—R9)1T6-T6aa� C, Ear (S03)227-1771 1521 S,W. Salmon Street ,QppESSt,paimmer @epbb.Can FROb1TdER 00004902 Portland OR 97205-1783 INSURER(S) AFFORDING COVERAGE NAIC0 INSURED INSURERA Continental Western Insurance INSURER B: RW Hays Co Inc, DBA: Hays Oil Company INSURERC: BiMor Stations Inc INSURER D: PO BOX 1220 INSURER E: Medford OR 97501 INSURER F: -•_— ^.-. J– COVERAGES C5RTIFICATENUMBER:11-12 GL, Auto, Umb 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. IN TYPE OF INSURANCE POLICY NUMBER MM1UOO MLNpprYYP LIMITS --^^ GENERAL LIABILITY EACH OCCURRENCE IF 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES R a iAk V 91 ,, $�� 100,000 A CLAIMS-MADE Exclaccur DY293B039 7/1/2011 7/1/2012 MEDELPNn onepenon S 5,000 PERSONAL L ADV INJURY $ 1,000,000 GENERAL AGGREGATE 5 2,000,000 GI AGGREGATE LIMIT APPLIES PER: PRO DUCTS_COMPIOPAGG 5 2,000,000 X POLICY PRO• LOC - — 5 AUTOMOBILELIABIUTY COMBINED SINGLE LIMIT 5 1,000,000 (EA aradent) X ANY AUTO BODILY INJURY(Perpereon) $ A ALL OWNED AMO3 Op2938039 /1/2011 /1/2012 BODILY INJURY(Per aradenl) $ SCHEDULEDAUT03 PROPERTY DAMAGE HIRED AUTOS (PUeradafl) 3 NON•OWNED AUTOS Uninsured mebrat mmbdnd 5 PIP-Basle 5 UMBRELLA LI-B N OCCUR EACH OCCURRENCE -_ 5 10,000,000 X EXCESSLUIB CLAMS-MADE AGGREGATE_ A E 10,000,000 DEDUCTIBLE J S A RETENTION 3 NIL 02998060 11/2011 /1/2012 a MIORNERS COMPENSATION W SSTAtZ. OTH. AND EMPLOYERVIJABIUTY YIN '�0 I ER ANY PROPRIETORIPARTNERIEXECUTIVE a NIA E.L.EACH ACCIDENT $ _- OFFICERIMEMBER EXCLUDED? (Mandaton In NMI 8.1-DISEASE-EA EMPLOYEE 3 If ea AMA under E.L DI$EA$E- D 8 TIo OF OPERATIONS below POUOY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES (4ttach 4CORD 1m,Addl0onal Rcmarka&hedula,It.mgl<apac<la mqulrcd) Re: Polieory of Fuol, The City Of Ashland, Oregon and its Bloated officials, Officers and Employeaa are included as Additional Inaureds per forms Cw 3130 (09 06) and CW 1054L (01 90) attached, xlLia Insurance is Primary and Non-Contributory. SubjeCt to policy terms, conditions and exclusions. CERTIFICATE HOLDER CANCELLATION (541)488-5320 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. Issued by Federated AUTXORRED REPRESENTATIVE 90 N Mountain Ave Ashland, OR 97520 Pam Wimmer/PW ACORD 25(2009109) ®19882009 ACORD CORPORATION. All rights reserved. INS025(200909) The ACORD name and logo are registered marks q1 NECORDER JUN-20-2011 13:30 ELLIOTT POWELL BHllEN I3HKE n0,52(4'(b44 P.b.S POLICY NUMBER: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ) MANUSCRIPT ENDORSEMENT I This endorsement modifies insurance provided under the Rollowing: COMPIERCIAL PROPERTY COVERAGE PART BUSINESSOWNERS i Q INLAND MARINE Q CRIME COVERAGE PART COMMERCIAL AUTO COVERAGE PART ® COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS COMPLETED OPERATIONS LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART COMMERCIAL UMBULLA POLICY Cj WOPJ<ERS'COMPENSATION POLICY ADDITIONAL INSURED - PRIMARY COVERAGE - SCREDULEO PERSON OR ORGANIZATION (continued) Name of Additional Insured Persons) Or Organization(s) Any person or organization whom you are required to name as an additional insured on thin policy under a written contract or agreement. Such written contract or agreement must be executed prior to the "bodily injury" or "property damage". No such person or organization is an insured with respect to any occurence that takes place after expiration of the written contract or agreement between you and such person or organization. 1 i CW 10 54 01 90 TOTAL P.03 JUN-20-2011 13:29 ELLIOTT POWELL HRDEN HRKE 5032747644 P.02 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. C W 31 30 09 06 ADDITIONAL INSURED - PRIMARY COVERAGE - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Persons Or Or anization s : Blanket Additional Insured perform CW3130 and CW1054L ' c/o RW Hays Go 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 II—Who Is An Insured is amended to include as an additional insured the person($) or organization(s) shown in the Schedule, but only with respect to liability for 'bodily 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 omissions of those acting an your behalf; in the performance of your ongoing operations for the additional insured(s) at thelocation(s)designated above. B. With respect to the insurance afforded to these additional insureds, the fallowing additional exclusions apply: This insurance does not apply to"bodily injury" or"property damage"occurring after: 1. All work, including materials, 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 its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With 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 contribution.under any insurance policy under which such additional insured is a named insured, if such policy was procured and paid for by such additional insured, or a parent or related entity of such additional insured.