HomeMy WebLinkAboutInsurance Certificate: Professional Underground Services ACORD 07
CERTIFICATE OF LIABILITY INSURANCE / /
07/1199/2201011)
1
PRODUCER (360) 892-5840 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Post Insurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1499 BE Tech Center Place ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 150
Vancouver WA 98683- INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURERA Bituminous Fire & Marine
Professional Underground Services, Inc. INSURER B:
P.O. BOX 2641 INSURER C:
NSURER D:
,Eugene OR 97402— INSURER E:
COVERAGES
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.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION
LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE MMIDDfYV DATE MMIDDM' LIMITS
GENERAL LIABILITY CLP 3 557 148 07/22/2011 07/22/2012 EACH OCCURRENCE 6 1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 100,000
PREMISES Ea ocwnence 6
A 7 CLAIMS MADE FX] OCCUR / / / / MED EXP(Any one son 3 10,000
PERSONAL 8 ADV INJURY $ 1,000,000
GENERAL AGGREGATE 6 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG 3 2,000,000
POLICY X JECOT LOC
AUTOMOBILE LIABILITY CAP 3 557 149 07/22/2011 07/22/2012 COMBINED SINGLE LIMIT
X ANY AUTO (Ea accident) $
1,000,000
A ALL OWNED AUTOS / / / / BODILY INJURY rs
SCHEDULED AUTOS (Per peon) 3
X HIRED AUTOS / / / / BODILY INJURY
IX NON-OWNED AUTOS
(Per accident) $
PROPERTYDAMAGE
(Per accident 3
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT 3
ANY AUTO / / / / OTHER THAN EA ACC 6
AUTO ONLY: AGG $
A EXCESS/UMBRELLA LIABILITY CUP 2 590 347 07/22/2011 07/22/2012 EACH OCCURRENCE $ 5,000,000
X1 OCCUR 7 CLAIMS MADE AGGREGATE 6 5,000,000
3
DEDUCTIBLE / / / / $
X RETENTION $10,000
7U 9
WORKERS COMPENSATION AND / / / / TO LIMITS ER
EMPLOYERS'LIABILITY
ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT 3
OFFICER/MEMBER EXCLUDED? / / / / E.L.DISEASE-EA EMPLOYEES
If yes,describe under
SPECIAL PROVISIONS bai. E.L.DISEASE-POLICY LIMIT 3
A I OTHER inland Marine CLP 3 557 148 07/22/2011 07/22/2012 scheduled Equipment 421,000
Rented Equipment 250,000
Deductible 500
DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLE$/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
RE: I5/Exit 14/Hwy 66 relocation of electric facilities from overhead to underground.
The City of Ashland is included as an additional insured with respects to the operation of the named insured.
-. n
CERTIFICATE HOLDER CANCELLATION $'
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30 DAYS W rOTSt N NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT
City of Ashland FAILURE TO DO L IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
90 N Mountain Ave INSURER ITS AG REPRESENT ATIVES.
AUTHOre R EN ATI
Ashland OR 97520-
ACORD 25(2001108) 0 ACORD CORPORATION 1988
INS025(oloe).aB Page I of 2