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HomeMy WebLinkAboutInsurance Certificate: Pump Pipe & Tank Services OP ID: C1 CERTIFICATE OF LIABILITY INSURANCE DAT 11/07/111 1 YY) 11/07 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 617-640-5035 CONTACT Monroe&Monroe Insurance 817-640-0131 PHONE FAX AIC No Ext: (AIC No): Agency, Ltd. E-MAIL 2921 Galleria Dc ADDRESS:, Suite 102 PRODUCER PUMPP-1 Arlington,TX 76011 CUSTOMER ID N' -film Beam ('Ir INSURER(S)AFFORDING COVERAGE NAICa INSURED Pump Pipe&Tank Services INSURERA:Mid-Continent Casualty Co. 23418 Robert D McHenry INSURER B: Box 146 INSURER C Talent,OR 97540 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 INSR SUER POLICY NUMBER MMIDCO/YEVYY MMIDDNYYY LIMITS LTR GENERAL LIABILITY I EACH OCCURRENCE $ 1,088,88 A X COMMERCIAL GENERAL LIABILITY 04GL8345458 11/15/11 11/15N2 DAMA---GET RENTED 100,00 PREMISES Ea occurrence $ CLAIMS-MADE � OCCUR MED EXP(Any one person) $ C X Pollution Liab PERSONAL B ADV INJURY $ 1,000,00 X Professional Liab GENERAL AGGREGATE $ 3,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGO $ 3,000,08 X POLICY PRO LOG $ FrT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accitlenp ANY AUTO - BODILY INJ URY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accidenq 8 SCHEDULED AUTOS Q PROPERTY DAMAGE $ HIREDAUTOS ((v= If�� (Per accitlent) NON-OWNED AUTOS $ UMBRELLA LIAB OCCUR NOV 14 2011 1 EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE S RETENTION $ WORKERS COMPENSATION'-- — - WG STATU= OTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDEDP ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ A Equipment Floater 041M45086 11/15/11 11/15/12 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION CASHLAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CI of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City ACCORDANCE WITH THE POLICY PROVISIONS. 20 E. Main Street Ashland, OR 97520 AUTHORIZED REPRESENTATIVE I ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD