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HomeMy WebLinkAboutInsurance Certificate: Metal Masters Inc --l's"I'll OP ID: KIY '4��° CERTIFICATE OF LIABILITY INSURANCE DATE 09130DYYYY) 09/30/11 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 541-773-5358 NAME, Kendall Yeaw Protectors Insurance,LLC PHONE FAX Pilot Rock Ins Agency LLC(CA) 541-772-1906 uc N. E111541-842-2963 INC No: 541-772-1906 PO Box 4669 E-MAIL ADDRESS:kendally@protectorsins.com Medford,OR 97501 PRODUCER ,METAL-1 Dennis C.Flenner CUSTOMER ID . INSURER(Si AFFORDING COVERAGE NAIC p INSURED Metal Masters Inc INSURERA:Liberty Northwest Insurance Co 41939 3825 Crater Lake Hwy INSURER B:SAIF Corporation Medford,OR 97504 INSURER C: INSURER D: 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 L POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDDIYYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 • X COMMERCIAL GENERAL LIABILITY C18150259 10/01/11 10/01112 PREMISES(Ea occurrence $ 100,00 CLAIMS-MADE FXI OCCUR MED EXP(Any one person) $ 5,00 PERSONAL B ADV INJURY $ 1,000,00 GENERAL AGGREGATE r $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,00 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00 (Ea accident) • X ANY AUTO C18150259 10101/11 10101/12 BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per eminent) NON-OWNED AUTOS $ $ UMBRELLA LIAB I IOCCUR EACH OCCURRENCE $ 1,000,00 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,00 A 018150259 10/01/11 10101112 DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION X WC$TATU- OTH- ER AND EMPLOYERS'LIABILITY TRY LIM B ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 812256 10/01111 10/01/12 E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? El NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (AKach ACORD 101,AddIdonal Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION CITYASH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Hall ACCORDANCE WITH THE POLICY PROVISIONS. Ashland,OR 97520 AUTHORIZED REPRESENTATIVE Dennis C. Flenner ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD