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' ',- 1 ® DATE(MMIDDIYYYY) <br /> Aj Ro CERTIFICATE OF LIABILITY INSURANCE <br /> 1/31/2020 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT <br /> NAME: <br /> Ballard&Co Inc Insurance PHONE 208-323-8214 (AIc,No):208-322-0273 <br /> 851 E. Fairview Ave. IA/C.No.Extl: <br /> Meridian ID 83642 ADDRESS: certificate@ballardandco.com <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A:Wilshire Insurance Company 13234 <br /> INSURED SITEI-2 INSURER B:Northfield Insurance Company 27987 <br /> Site Inspection Service, LLC <br /> 2390 Alameda Street NE INSURER C: <br /> Salem OR 97301 INSURER D: <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:1087650209 REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSRLICY EXP <br /> LTTYPE OF INSURANCE INSD SUER POLICY NUMBER (MMIDD//YYYY) (MLICY EFF M/DD/YYYY) LIMITS <br /> LTR INSD WVD <br /> B X COMMERCIAL GENERAL LIABILITY WS394897 9/21/2019 9/21/2020 EACH OCCURRENCE $1,000,000 <br /> DAMAGE TO CLAIMS-MADE X OCCUR PREMISES(Ea occu RENTED <br /> $100,000 <br /> MED EXP(Any one person) $5,000 <br /> PERSONAL&ADV INJURY $1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 <br /> POLICY PRO- <br /> JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 <br /> OTHER: $ <br /> A AUTOMOBILE LIABILITY BA2603929 7/10/2019 2/11/2020 COMBINED SINGLE LIMIT $1,000,000 <br /> (Ea accident) _ <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED x SCHEDULED <br /> AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY (Per accident) <br /> $ <br /> UMBRELLA UAB _ OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION PER <br /> AND EMPLOYERS'LIABILITY Y/N STATUTEH <br /> ER <br /> ANYPROPRIETOR/PARTNERJEXECUTIVEN/A E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBEREXCLUDED? <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> A Broadform Cargo BA2603929 7/10/2019 2/11/2020 Limit $100,000 <br /> Double Wide End Included Ded $1,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Sundial Mobile Home Park <br /> 2310 Landcaster Dr SE AUTHORIZED REPRESENTATIVE <br /> Salem OR 97317 riti alliit <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />