Certificate of Insurance
ACORQM CERTIFICATE OF LIABILITY INSURANCE T DATE (MM/DDIYYYY)
06/29/2005
~~-~~ FAX (541)488-5851
PRODUCER (541)482-0831 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Ashland Insurance, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
585 A Street Suite 1 @Imn<antNI~{b HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P. O. Box 880
Ashland, OR 97520 INSURERS AFFORDING COVERAGE NAIC#
INSURED Garry Price INSURER A: American States 19704
3200 Anderson Creek Rd. INSURER B:
Talent, OR 97540 INSURER C:
INSURER D:
INSURER E:
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I~~~ ~~'?,'~ TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE
GENERAL LIABILITY 01CG1632 5 54 04/02/2005
I--
X
A X
COMMERCIAL GENERAL LIABILITY
l CLAIMS MADE m OCCUR
P~~!f~Y EXPIRATION
04/02/2006
LIMITS
-
-
GEN'L AGGREGATE LIMIT APPLIES PER:
---, nPRO. n
I POLICY JECT LOC
AUTOMOBILE LIABILITY
I--
-
ANY AUTO
-
ALL OWNED AUTOS
-
SCHEDULED AUTOS
HIRED AUTOS
-
I--
NON-OWNED AUTOS
GARAGE LIABILITY
==J ANY AUTO
EXCESS/UMBRELLA LIABILITY
b OCCUR 0 CLAIMS MADE
R DEDUCTIBLE
RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR!PARTNER/EXECUTIVE
OFFICER!MEMBER EXCLUDED?
If yes. describe under
SPECIAL PROVISIONS below
OTHER
~ t0iJ1l, ('\HA{-.r-,
. l) 4~ ~:~ (~/:~~ ~ 2:~
Lcl..--:~- r) <)
.Y:- )'::.:.c;
."n __. '._ _, _...___
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
~-mail address: curry-gay@monroecounty-fl.gov
~he Monroe County Board of County Commissioiners, its employees and officials will
included as "Additional Insured" on all policies except worker's compensation.
~ith respects to work performed by the insured
CERTIFICATE HOLDER
C.4NCI=LL.4 TION
b~fI&ur
NOV 2~5
.- T\...,;//
The Monroe County Board of County
Commissioners It's Employees and Officers
Attn: Monica Haskell
1100 Simonton St
Key West, FL 33040
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IM~NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER, ITS AGENT' OR RE),RESENTATIVES. ~
AUTHORIZED REPREflENT~ I \ Md \ ~ r
Jul ie Asher \. j \,. J J 0 \^ 0 .x-\ cx..
0" ~ACORD CORPO~\rION 1988
ACORD 25 (2001/08) FAX: (305)295-4372
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the pOlicies listed thereon.
ACORD 25 (2001/08)