HomeMy WebLinkAboutInsurance Certificate: Valley Slurry Seal Co OP ID: MY
CERTIFICATE OF LIABILITY INSURANCE °"T 021021IYYYY'
02/02/12
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
650573-1111 NAME:
Andreini&Company-San Mateo 650-378-4361 P"ONE FAX
License 020882° NC No Ert: INC.No),
220 West 20th Ave E-MAIL
ADDRESS:
San Mateo,CA 94403 PRODUCER BASIC-1
Mike Brunn CUSTOMER ID a:
INSURER(S) AFFORDING COVERAGE NAIC8
INSURED Valley Slurry Seal Company INSURER A:National Union Fire Ins Co PA 19445
dba:VSS Emultech INSURER B:Starr Indemnity&Liability Co 38318
3785 Channel Drive INSURER C:StatO Com ensation-0re on
West Sacramento,CA 95691
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 MNID r EFF POLICY EXP
LTR UNITS
GENERAL LIABILITY EACH OCCURRENCE E 2,000,09
• X COMMERCIAL GENERAL LIABILITY GL4870830 03101112 03101/13 PREMISES Ea occurrence $ 190,09
CLAIMS-MADE Ix I OCCUR MED EXP(Any one Person) $ 10,09
PERSONAL&ADV INJURY $ 2,000,09
GENERAL AGGREGATE E 4,000,09
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 4,000,09
.POLICY I-XI PRO- LOG $
lFrIT F1 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 2,000,09
Ea• X ANY AUTO CA8263794 03101112 03101113 BODILY INJURY BODILY INJURY(Per person) $
ALL OWNED AUTOS BODILY INJURY(Per accident) $
SCHEDULED AUTOS
PROPERTY DAMAGE $
X HIRED AUTOS (Per accident)
X NON-OWNED AUTOS $
E
UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 6,000,09
EXCESS LIAR CLAIMS-MADE AGGREGATE $ 5,000,00
B SISCCCL00006511 03101/12 O3101/t3
DEDUCTIBLE E
RETENTION $ $
WORKERS COMPENSATION X. WC STATU- OTH-
AND EMPLOYERS'IJABILITY TORY LIMITS ER
TORYL
MIT
C OFFICERPRIE EREXCLUDRIE ECUTIVE YI❑N NIA 497123-OREGON 04/01/12 04/01/13 E.L.EACH ACCIDENT $ 500,09
(Mendatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,00
It yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES?(AKach ACORD 101,AddMonel Remelts;Schedule,N wns space is required)
nns t a U M
CERTIFICATE HOLDER Ul I
art CANCELLATION
FEB — 6 2O1ZAS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS.
20 East Main Drive
Ashland,OR 97520 AUTHORIZED REPRESENTATWE
BOA
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