E AND B OILFIELD SERVICE INC - Laserfiche WebLink

Home

ACORO® CERTIFICATE OF LIABILITY INSURANCE i`/ DATE(MNIDD /YYYY) 1 12/28/2016 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 Craig ith NAME: q mO Y PHONE FAX A/C No Est : A/C No ISU — Service InallrdnCe Agency f Roosevelt, Inc. Y ADDRIEss:ctimothy @srvins.com PO BOX 647 610 E 200 N INSURER(S) AFFORDING COVERAGE NAIC# INSURERA:Falls Lake National Insurance Cc EACH OCCURRENCE Roosevelt UT 84066 INSURED INSURER B National Specialty Insurance INSURER C: E&B Oilfield Service, Inc. INSURER D: Rt 1 BOX 1112 INSURER E • MED EXP(Ar one person) 1 INSURER F: Roosevelt UT 84066 COVERAGES CERTIFICATE NUMBER:16 /17 certs 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM /DDY EXP LIMITS X COMMERCIAL GENERAL LIABILITY Craig Timothy /SN O EACH OCCURRENCE $ 1,000,000 A CLAIMSTMADE X OCCUR DAMAGE TO RENTED PREMISES Ea UCCUrmnce $ 100,000 • MED EXP(Ar one person) $ 5,000 Pollution X CPP0267270 8/9/2016 8/9/2017 • XCU Included PERSONAL S ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY J'E'CT LOC APPROVED] X PRODUCTS AGO $ 2,000,000 $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea..dent $ 1,000,000 X BAP0253177 BODILY INJURY(Pupeemn) $ A ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X 8/9/2016 8/9/2017 BODILY INJURY(Pu amdent) $ PROPERTY DAMAGE Pmm,adent $ NONOWNED HIRED AUTOS AUTOS PIP41asic $ 3,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10 000 000 AGGREGATE $ 10 000 000 B EXCESS LIAB CLAIMSTMADE DED X RETENTION 10,000 $ U1®0256463 8/9/2016 8/9/2017 WORKERS COMPENSATION YIN X STATUTE STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACHACCIUENT $ 1 000 000 A OFFICERIMEMBER EXCLUDED? ❑ (Mandatmy in NH) N/A CPP0267270 8/9/2016 8/9/2017 EL DISEASE - EA EMPLOYEE $ 1,000,000 K yes, describe undcr DESCRIPTION OF OPERATIONS below Stop Gap Liability ONLY E L DISEASE - POLICY LIMIT $ 1 '000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached amore space is required) Certificate Holder is listed as Additional Insured when required by written contract. (endorsement form numbers Auto MSIG 120 01 13 6 GL MSIG 151 12 12) CERTIFICATE HOLDER CANCELLATION ACORD 25 (2014/01) INSO25 (20140 1) ©1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of Riverside California THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 3900 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Riverside, CA 92522 AUTHORIZED REPRESENTATIVE Craig Timothy /SN O ACORD 25 (2014/01) INSO25 (20140 1) ©1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD