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HomeMy WebLinkAboutInsurance Certificate: TRISTAR Insurance Group Pf$OWEtlIMI$ o '� Z'® CERTIFICATE OF LIABILITY INSURANCE 0DATE 7/0 /2012 r) 07/03/2012 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 LL BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. p IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)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 1-818-539-2300 CONTACT Arthur J. Gallagher 4 Co. PHONE FAX I' Insurance Brokers of California, Inc. License #0726293 WC_NS Ext, WC,Nn), j 505 North Brand Boulevard, Suite 600 E'MaL ADDRESS: Glendale, CA 91203-3944 INSURER($)AFFORDING COVERAGE NAICS 818-539-2300 INSURER A: PaCi INS CO 20281 INSURED INSURER B: HARTFORD UNDERWRITERS INS CO 30104 TRISTAR Insurance Group, Inc. INSURER L: NATIONAL UNION PIPE INS CO OF PITT$ 19495 100 OCeangate Avenue, Suite 700 INSURER D: ChartiS Specialty Insurance Company 26883 Long Beach, CA 90802 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 28137773 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 TYPE Of INSURANCE ADDL 6UBk POLICY EFF POUCV E%P UNITS Lm POLICY NUMBER MMIDD MIIIDO A GENERAL LMENITY 35848060 01/01/1 01/01/13 EACH OCCURRENCE S 1,ODO,000 X COMMERCIAL GENERAL LIABILITY PREMSES�e0ccune.) 51,000,000 CI-AIMS-MADE I X OCCUR MED EXP(My me Povem) $10,000 X Incl. Contractual Liao PERSONALBADVIWURY $1,000,000 GENERALAGGREGATE $2.000,000 GB,11 AGGREGATE LIMN APPLIES PER PRODUCTS COMPIOPAGG SIncl.ADOve POLICY PRO- X LOC $ JFCT B AUTOMOBILE WBaffY 72UECKR9463 01/01/1; Ol 1/ COMBINED SINGLE UMIT (Eea t) 51,000,000 X MY AUTO BODILY IMURY(Per P n) S AIL OWNED SCHEDULED BODILY INJURY(P.,aaldenl) $ AUTOS AUTOS NON-OWNED PROPERTYDAMAGE S HIREDAUTOS AUTOS Pmaaidml S C UMBRELLA LBIB X OCCUR 10021662262 01/01/1 01/01113 EACH OCCURRENCE S 5,000,000 EXCESS LMB CVJMSMADE AGGREGATE $51000,000 DIED I RETENTIONS $ WORKERS COMPENSATION WC STATU- OTK AND EMPLOYERS'LIABILITY YIN IQRYUMITS ANY PROKHETORIPARTNER,EXECUTNE E.L.EACH ACCIDENT S OFFICERIAWBER EXCLUDED? NIA (Mandamry in HH) EL DISEASE-EA EMPLOYE S Hyyea,desmTe m,der DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ D Errors 4 Omissions 01-456-76-23 01/01/1 01/01/13 Aggregate 10,000,000 C Crime 01-450-15-52 01/01/1 D1/01/13 Aggregate: 5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IAtlxb ACORD 101,AddtUmal Remake Schedule,if man we H,e9uind) City of Ashland is named additional inured under General Liability as respects their interest in the operations of the Named Insured. RECORDER "Additional Insured by endorsement #80-02-2367 Pd. B-04" DER CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Hari Olson 90 N. Mountain Ave. AUHORRED REPRESENTATIVE Ashland, OR 97520 USA VV ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD njobansing 28137773 PSIa,J3NVJl Liability Insurance m 0 N Endorsement 0 N r_ PollcyNumber 3584-80-WUC Insured TRISTARINSURANCEOROUP Name of Company FEDERALINSURANCECOMPANY This Bndorsementapplies to thefollowing forms: GENF.RALLIABILITY Under Who Is An Insured,the followingprovision is added: Who Is An Insured ScheduledPersonOr Subject to 911 Of the terms and conditions ofthIs Insurance,any person or organizationshown.in the Organization Schedule,acting pursuant to a mitten contract or agreement between you acrd such person or organization,is an Insured;but they are Insureds only with respect to liability arising out ofyour operations,or your premises,ifyuu are obligated,pumuantto such contract or agreement,to provide them with such insurance as is afforded by this policy. — If owover,no such person or organization isan Insured with respect toany: assumplionof liabilityby them Ina contract or agreement.This limitation does not apply to the Iiabilllyl'or damagesfor injury or damage,to which this insurance applies,that thoperson ororganizationwouldhave lu the absence of such contract or agreement. damages arising out of theilr sole negligence. Schedule PERSONSOR ORGANIZATIONSTHATYOU AREOBLIGATIID,PURSUANTTO WRrrrPNCONTRACrOR AGRBBMBNTBRT WBBNYOU AND SUCHPERSON OR ORGANIVATION,TO PROVIDBWITH SUCH INSURANCBAS 18 AFFORDHD BY11118 POLICY;BUTTHEY ARE INSUREDS ONLY IF AND TO TIIEMINIMUMEXTENTTHAT SUCH CONTRACTORAGRHRMRNT REQUJIUMHE PERSON OR ORGANIZATIONTO BE AFFORDED STATUS AS AN INSURED. HO\VBVLR,NO PERSON OR OROANIZATIONIS AN INSUREDUNDERTHIS PROVISION WHG IS MORE SPECIFICALLYDESCRIBEDUNDER ANY OTHER LWa@ry Insurance coraMued fomr 9a-02-?304Rev,a-04) Endorsement Pago I eszauzwut - r C O M L/abi ly Endorsement (continued) N PROVISIONOFTHE 1VHOIS AN INSIIREI)SECTIONOF TIES POLICY w (REGARDLESSOF ANY IR&TATIONAPPLICAHLBTHEMTO). All olhertenns end conditions renminunchunged. ANhorhod Rapre ntawa Liae88y(nsuradw lastpaga Fomr 80-02-2364Rov.8-01) Endwsanrent gaga 2 PSIOWIb1U3 ' Arthur J.Gallagher& Co. 505 North Brand Boulevard, Suite 600 Glendale,CA 91203-3944 mieumsma Electronic Service Requested E B IX B PO LL 0 3-DIGIT 975 17210 0.6871 AT 0.371 tlt�tllll�t�ltl�ll'�Ill�ll�rt�tl��llltt�tlllltllll��'�'I�Ill��lrt _ N r Cityy of Ashland 90 N• MOUNTAIN AVE. 60 ASHLAND, OR 97520-2014 Z m This document was brought to you by Ebix/CertificateeNow and Arthur J. Gallagher & Co. Insurance Brokers of California, Inc. in Glendale, CA.- Any documents forwarded with the certificate request were reviewed for the sole purpose of completing the certificate.- If you have questions regarding the content of this document, please contact the Producer/Agent listed on the certificate of insurance. - The data included in this notice and in the attached document is confidential to Ebix/CertificateeNow and Arthur J. Gallagher & Co. Insurance Brokers of California, Inc.- Co. 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