HomeMy WebLinkAboutTELELANGUAGE INC - INSURANCE CERTIFICATE (6)ter-, TELEL-1 OP ID: JE
DATE (MM/DDNYYY)
,4coRo CERTIFICATE OF LIABILITY INSURANCEF�.. 01 /31 /2017
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).
CONTACT
PRODUCER NAME: J. Darrin Gross
Leonard Adams Insurance, Inc. PHONE FAX
5201 SW Westgate Dr, Suite 300 (,C. No. E.503-296-0077 A/C No : 503-296-0044
Portland, OR 97221 E-MAIL
J. Darrin Gross ADDRESS: darring@lacoinsurance.com
INSURERS) AFFORDING COVERAGE NAIL #
INSURER A: Sentinel Insurance Company 11000
INSURED Telelanguage Inc INSURER B: SAIF
514 SW 6th Ave, 4th FI INSURERC:
Portland, OR 97204
INSURER D
INSURER E :
INSURER F :
w IRA—M. P9=VI4ZIr)KI NI IRARFR•
vTHIS 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.
mgPLICYIEFF POLICY
,TYPE OF INSURANCE INSD SUB
LTR POLICY NUMBER MM/DDfYYYY MM/DDIYYYY) LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,00
CLAIMS -MADE X OCCUR
X
52 SBA PW5861
03/17/2017
03/17/2018
DAMAGE TO RENTED
PREMISES Ea occurrence
$ _ 1,000,00
MED EXP (Any one person)
$ 10,00
PERSONAL & ADV INJURY
$ 1,000,00
GEN'L
AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,00
PRODUCTS - COMP/OPAGG
$ 2,000,00
POLICY JECT PRO LOC
OTHER:
Emp Ben.
$ 1,000,00
AUTOMOBILE LIABILITY
BIN
ED M..d.DiSINGLE LIMIT
$ 1,000,00
BODILY INJURY (Per person)
$
A
ANY AUTO
52 SBA PW5861
03/17/2017
03/17/2018
BODILY INJURY (Per accident)
$
ALL OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
X HIRED AUTOS X AUTOS
PROPERTY DAMAGE
Per accident
$
$
X
UMBRELLA LIAB
X
OCCUR
EACH OCCURRENCE
$ 2,000,00
AGGREGATE
$ 2,000,00
A
EXCESS LIAB
CLAIMS -MADE
52 SBA PW5861
03/17/2017
03/17/2018
DED I X I RETENTION $ 10,000
$
WORKERS COMPENSATION
X PER
STATUTEI ERR
B
AND EMPLOYERS' LIABILITY IN
ANY PROPRIETOR/PARTNER/EXECUTIVE Y�
X
799269AR(OREGON)
04/01/2016
04/01/2017
E.L. EACH ACCIDENT
$ 500,00
E.L. DISEASE - EA EMPLOYEE
5OO OO
$ ,
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
N/A
E.L. DISEASE -POLICY LIMIT
$ 500,00
If yes, describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Certificate holder is named as an additional insured with respect to
General Liability.
CERTIFICATE HOLDER GANIaLLA I IVry
CITYOFF
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS.
P.O. Box 580
Fort Collins, CO 80522 AUTHORIZED REPRESENTATTII/VEE
J. Darrin Grose '/' A'
U 1988-2014 ACUKU L:UKNUKA I IUN. An ngnis reservea.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD