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HomeMy WebLinkAboutInsurance Certificate: Grayback Forestry Inc OP ID: KIY CERTIFICATE OF LIABILITY INSURANCE DAT12/222/„2/11/ YY) 2 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 CONTACT Kendall Yeaw Protectors Insurance,LLC 541-772-1906 Lpva rt,541-842-2963 FAX No): 541-772-1906 Pilot Rock Ins Agency LLC(CA) PO Box 4669 EMAIL Medford,OR 97501 ADDRESSRkendall rotectorsins.com R.Joe Hubbard CUSTOMER ID,GRAYB-1 INSURERS AFFORDING COVERAGE NAIC N INSURED Grayback Forestry Inc INSURER A:American States Insurance Co 19704 Western Emergency Services LLC INSURER B:Safeco Insurance Company 24740 PO Box 838 INSURER C Merlin,OR 97532-0838 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 rypE OF INSURANCE D PODGY NUMBER MMIDDY� MMIDDY/YYYY LIMITS LTR GENERAL UABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY 01C131118230 01/01/12 01/01/13 PREMISES Ea occurrence $ 100,00 CLAIMS-MADE FxI OCCUR MED EXP(Any one Person) $ 5,00 PERSONAL B ADV INJURY $ 1,000,00 X Loggers Broad GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY X PRO- LOC $ JECT AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT $ 1,000,00 B X ANYAUTO 26CCO0763910 01101112 01101/13 (Ea eccidem) BODILY INJURY(Per person) $ ALLOWNEDAUTOS BODILY INJURY(Per accidenQ $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per awidenq NON-OWNED AUTOS POLLUTION $ 1,000,00 B X POLLUTION 26CCO0763910 01/01/12 01/01113 $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,00 EXCESS UAB CLAIMS-MADE AGGREGATE $ 5,000,00 A 01SU41705730 _ 01101112 01/01113 DEDUCTIBLE $ X RETENTION $ 10,000 $ WORKERS COMPENSATION WC STATU-777M AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNEREXECUn ❑VE NIA E.L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,deemed under DESCRIPTION OF OPERATIONS bel. E.L.DISEASE-POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Adach�/(ACORD 101,Additional Remarks Schedule,If more space is required) �J � V CERTIFICATE HOLDER ANCELLATION DEC 2 1 %ffAS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland City Main Street ACCORDANCE WITH THE POLICY PROVISIONS. 20 Ashland,OR 97520 THORRED REPRESENTATIVE Joe Hubbard ©,988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD