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HomeMy WebLinkAboutInsurance Certificate: Welburn Electric Inc OP ID: KIY CERTIFICATE OF LIABILITY INSURANCE DAT12/12DYYYY) v12N 1 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 CONTACT 541-773-5358 NAME: Kendall Yeaw Protectors Insurance,LLC 541-772-1906 P"ONE Fax Pilot Rock Ins Agency LLC(CA) AC Ne Eat,541-773-5358 INC No): 541-772-1906 PO Box 4669 E-MAIL Medford,OR 97501 ADDRESS: kendally@protectorsins.com PRODUCER WELBU-1 R.Joe Hubbard C MER ID k: INSURERS AFFORDING COVERAGE NAIC k INSURED Welburn Electric Inc INSURER A:North Pacific Insurance PO Box 329 INSURER B: Phoenix,OR 97535 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 rypE OF INSURANCE POLICY EFF POLICY UP LTR POLICY NUMBER MM/DDIVYYV I fMM/DD/YYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY 019127353 12123/11 12123112 PREMISES Ea occurrence $ 100,00 CLAIMS-MADE Fx_� OCCUR MED UP(Any one person) $ 5,00 PERSONAL B ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP)OP AGO $ 2,000,00 POLICY X PRO- LOC $ AUTOMOBILE LUABIUTY COMBINED SINGLE LIMIT $ 1,000,00 (Ea A X ANY AUTO C19127353 12123111 12/23/12 BODILY INJURY J NJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ NON-OWNED AUTOS $ y� $ UMBRELLA LIAB OCCUR D EACH OCCURRENCE $ EXCESS LI AB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE S RETENTION $ 1 $ WORKERS COMPENSATION WC STATU- OTH- ANDEMPLOYERS'LIABILPY Y/N ANY PROPRIETOR/PARTNERIEXECUTIVE ❑ E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,descnbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACech ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION CITYAS2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 E Main Str ACCORDANCE WITH THE POLICY PROVISIONS. Ashland,OR 97520 AUTHORIZED REPRESENTATIVE R.Joe Hubbard ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD