HomeMy WebLinkAboutInsurance Certificate: Project A ACOBQ. CERTIFICATE OF LIABILITY INSURANCE 9/1/2011'
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Paul Volz Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
450 Siskiyou Blvd. Ste. 5 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Ashland, OR 97520 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
541-482-8463 ', - INSURERS AFFORDING COVERAGE NAICN
INSURED Jim Teece - INSURERA Farmers Insurance Exchange
DBA: 'Project A INSURER B:
864 Neil Creek INSURER C'
Ashland, OR 97520 INSURER D:
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 O'L POLICY EFFECTRIE POLICY EXPIRATION
LTR NERD POLICY NUMBER DATE MWOD DATE WDDIYYI LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY PREMISES Ea amurenco $
CLAIMSMADE CI OCCUR MED EXP(Any one person) $
PERSONAL&ADV INJURY $
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $
POLICY JEC LOC
AUTOMOBILE LIABILITY COMBINED
ANYAUTO . — Ea aecdent,SINGLE LIMIT $ 1,000,000
ALL OWNED AUTOS -- -
X SCHEDULED AUTOS- '" (Perpemn) $ 1, 000 000
A HIREDAUTO$_'- _ 73 .03508-20-10 8/26/11 8/26/12 g001LYINJURV $ 1 000000
NON-OWNEDAUTOS (Peraoeident) T
- PROPERTY DAMAGE a
(Peramidenp r ,0�0
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANYAUTO
OTHER THAN EA ACC $
AUTOONLY: AGO a
EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR CI CLAIMSMADE AGGREGATE $
a
DEDUCTIBLE
a
RETENTION E Is
W AT
WORKERSCOMPENSATIONAND TOO RYLIMITS ER
EMPLOYERS'LIABILITY
ANY PROPRI BZRIPMTNEP/EXECUTIVE
E.L.EACH ACCIDENT Is
OFTILFJLMEMBER E%CLUDFJYI
E.L.DISEASE-EA EMPLOYE a
S E IAL PRO PROVISIONS E.L.DISEASE-POLICY LIMB $
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Coverage for Jim Teece and Project A.
CERTIFICATE HOLDER CANCELLATION
Ann Seltzer, Management Analyst SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Ashland DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MARS DAYS WRITTEN
20 East Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO$HALL
Ashland, OR 97520 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
REPRESE AT S.
A OR D PRESE AT
ACORD 25(2001/08) (6F:` _-�7-^---91&ACORD CORPORATION 1988