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HomeMy WebLinkAboutInsurance Certificate: Public Works Management OP ID:TP CERTIFICATE OF LIABILITY INSURANCE 12130/11 THIS ) 12/30/11 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 CONTACT 541-245-1111 NAME: PO Box 936 Therese Pritchett Solutions,Inc. 541-245-1112 PHO"NO E,t:541-494-7744 ac No: 541-245-1112 Medford,OR 97501.0067 A DRESS:therese.pritchett @unitedrisk.com CUSTOMER IO Workers Comp House Account PRODUCER .PUBLOIW INSURER(S)AFFORDING COVERAGE NAIC R INSURED Public Works Management, Inc. INSURER A:SAIF Corporation C/O RH 2 Engineering INSURER B: 22722 29th Dr SE Ste 210 INSURER C Bothel,WA 98021 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 POLICY NUMBER MMIDD LTR NYYY MMIDDNYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE OCCUR MED EXP(My one person) $ PERSONALBADVINJURY $ GENERAL AGGREGATE $ GENLAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PR0. LOG $ 'ECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea aoaident) ANY AUTO BODILY INJURY(Per person) $ ALLOWNEDAUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNEDAUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ Is WORKERS COMPENSATION X WCSTATIG OH- AND EMPLOYERS'LIABILITY TORY UMITS IT A ANY PROPRIETOR/PARTNEWEXECUTIVE YIN 967233 11/01/11 11101112 E.L.EACH ACCIDENT $ 500,000 OFFICERIMEMBER E%CLUDEp? NIA (Mandatory In NN) E ,DISEASE-EA EMPLOYEE $ 500,000 If yes,describe antler DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES Attach ACORD 101,Additional Remarks Schedule,Hmore space is required) ALL OPERATIONS OF THE NAMED INSUR D CERTIFICATE HOLDER CANCELLATION C17 I 0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland JAN - 4 2012 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 E Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland,OR 975 AUTHORIZED REPRESENTATIVE <0" P ©1988.2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD