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HomeMy WebLinkAboutInsurance Certificate: Southern Oregon-Robert Keller 09/07/2011 WED 14: 16 FAX 5415361568 Bancorp Insurance 100011001 A CERTIFICATE OF LIABILITY INSURANCE DATE(MMDDY YY) 9/7/2011 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANTI:;lf.--the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION 15 WAIVED, subject to the terms aii&conditions of the policy, certain policies may require an endorsement."A statement on this certificate does not confer rights to the l... ceni8cate'hblder in lieu of such endorsement(s). � CONTACT Pam Dressler PRODUCER NAME: Little River Investments PHONE (541)536-1726 FAX Me);(5.11 5 3 6-15 68 51477 Hwy 97 EMAIL .pam@bancorpinsurance.core P.O. Box 327 INSURER(Sf AFFORDING COVERAGE NAICa La Pine OR 97739 INSURERAAm Hallmark Ins Cc of TX INSURED INSURER B: Robert Jerome Keller, DBA: Southern Oregon [INSURER SURERC: 200 Rogue Rim Dr URERD: E: Merlin OR 97532 SURER F: COVERAGES CERTIFICATE NUMBER:CLi19711733 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 AOOL R POLICY NUMBER— PMMDDY EFF MMIDDIYE YY LIMITS LTR GENERAL LIABILITY EACH TO $ 1,000,000 X COMMERCIAL GENERAL LIABILITY REMIS RENTED 100,000 PREMIS Ea mcurren $ A CLAIMS-MADE ❑X OCCUR X 44CA446596 10/10/201110/10/2012 MED EXP(Any me eman $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERALAGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 X POLICY PRO LOC $IFCT COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED X BODILY INJURY(Per aocice,l) $ H AUTOS NON OWNED PROPE tle DAMAGE $ AUTOS Wer VMBRELLA UAB OCCUR EACH OCCURRENCE It EXCESS LIAB CLAIMS-MADE AGGREGATE If DED RETENTIONS $ WORKERS COMPENSATION !s CB I ff a e O tn� rance WC STATU- OTH- ANDEMPLOYERS'LIABILITY YIN regresent5 overeageC rrenfff ANY PROPRIETORIPARTNEWEXECUTIVE f E.l.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDEDi N 1 A !n effect anti YrtuV Or M y not E.L.DISEASE-EA EMPLOYE 8 (Moods my in NH) be la Con'ijtf—me w to If yes.describe under , E.L.DISEASE-POLICY LIMIT $ ❑ESCRIPTION OF OPERATIONS below' aria wr f ri nof.krs17$.° DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Aeach ACORD 101,Additional Remarks Schedule,ff more space is required) Certificate holder is listed as an Additional Insured per EN#MP97670406 attached. 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 ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland Purchasing Representative AUTHORIZED REPRESENTATIVE Attn: Kari Olson 90 N Mountain Avenue Ashland, OR 97520 - — Pam Dressler/PD ACORD 25(2010/05) - ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201008).OI The ACORD name and logo are registered marks of ACORD 'TY R C�I ��ER