HomeMy WebLinkAboutPermit Miscellaneous 2007-10-18
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ACORD
TM
PRODUCER (541)687-11.17
Ward Insurance Agency,
POBox 10167
Eugene, OR 97440
FAX (541)342-8280'
Inc.
DA TE (MM/DDfYYYY)
10/18/2007
THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
CERTIFICATE OF LIABILITY INSURANCE
INSURED Betty Trotter
294J Edgewater Drive
Eugene, OR 97401
! . ..~-.-~ ,.
INSURERS AFFORDING. COVERAGE
,-:
Travelers Property <.;asualty Co.
NAIC#
;. ....;
I INSURER A:
I INSURER B:
1 INSURER C:
1 INSURER D:
1 INSURER E:
','.'.
_ L
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOlWlTHSTANDING
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
_I~~: ~~ TYPE OF INSURANCE POLICY NUMBER PRH~~=mf Pgk'f:(~~~~.wlN
GENERAL LIABILITY 680-8293C749 10/25/2007 10/25/2008 EACH OCCURRENCE
"Xl COMMERCIAL GENERAL LIABILITY
I I CLAIMS MADECKJ OCCUR
LIMITS
I DAMAGE TO RENTED
PR~r\lUC::l=<::: fl:::~ r'l('r'llra,nr'a,\
1 , 000, 000
100,000
5,000
- i , 000:-000
2,000,000
2,000,000
GEN'lAGGREGATE LIMIT APPLIES PER:
~ . nPRO n
I POLICY JECr LOC
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
MED EXP (Anyone person) $
PERSONAL-&ADiiiNJl.JRY $
1 GENERAL AGGREGATE 1$
1 PRODUCTS - COMP/OP AGG I $
I
-A
COMBINED SINGLE LIMIT
(Ea accidenl)
BODILY INJURY
(Per person)
:;'
BODILY INJURY
(Per accident)
,J'j..
PR-OPERTY- DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
.. AUTO ONLY ~ EA ACCIDENT
OTHER THAN
AUTO' ONLY:
EA ACC
AGG $
1$
I $
1$
1$
1$
IOJ~-1
$
EXCESS/UMBRELLA LIABILITY
~ OCCUR D CLAIMS MADE
EACH OCCURRENCE
I AGGREGATE
I
I
I
1 I WC STATU- I
TORY liMITS
E.L. EACH ACCIDENT
DEDUCTI BLE
RETENTION
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes; describe under - - -'
SPECIAL PROVISIONS below
OTHER
A Property Coverage
680-8293C749 10/25/2007
10/25/2008
E.lDISEASE -EA EMPLOYEE_$
E.L. DISEASE - POLICY LIMIT $
$446,250 Bui Iding limit incls
Sign Coverage-Replacement Cost
Special form, $1,000 ded
DESCRIPTION OF OPERA TIONS I LOCA TIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
~E: 553 MAIN STREET, SPRINGFIELD, OREGON 97477
<::1S~T1FICA TE HOLDE~
CITY OF SPRINGFIELD,
ATTN DAVE BOlESBY
225 5TH STREET
SPRINGFIELD, OR 97477
~ANCELLA TJON
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICA TE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Kevin Banks/LACY
ACORD 25 (2001/08) FAX: (541)726-3676
@ACORDCORPORATION 1988