HomeMy WebLinkAboutInsurance Certificate: Tom Whisenant dba TLC Yellow Cab 01/04/13 07:52 AN PST via VSI-FAX Page 1 Of 1 #2120 f
AC 40 CERTIFICATE OF LIABILITY INSURANCE DATE,~~D°"""Y'
01/04/2013
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 POLICIE
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: N the certificate holder Is an ADDITIONAL INSURED, the polky(les) must be endorsed. If SUBROGATION IS WANED, Subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate dues not confer rights to the
certificate holder In lieu of such endorsement(s). CONrACr
NAME'
800-980-1950 iAA N.J. 800-980-1960
American Business Insurance a;
32107 Lindero Canyon Road
MDRESS.
Suite 120
INSURERS AFF VNG COVERAGE NAICN
Westlake Village, CA 91361 INSURER A Preserver Insurance Company 15586
INSURED
INSURER e
TOM whisenant dba TLC Yellow Cab
NsuRER c
278 Idaho Street #4
Ashland, OR 97520 INSURER D:
INSURER E :
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERT
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 TER
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
MR ADDL SUER 1`0C EFF POLICY ID(P
LTR TYPE OF W BI.RANCE POIICY Ms INIKDONYM
IIMRe
GENERAL LIARILuY EACH OCCURRENCE E
E
COMMERCULL OENE LIABILITY PREMISES (Ga
CIAIMSMADE F7 OCCUR MED EXP (Any one neon S
PERSONAL S ADV INJURY $
GENERAL AGGREGATE $
GENL AGGREGATE LIMIT APPUES PER: PRODUCTS - COMPAJP Asa $
POLICY PRO, LOC S
A q0*10BRE UAB BAPBZ0563513 01/03/2013 01/03/2014 COMBINED SINGLE UMTr 500,000
ANYAUMD BODILY IWURY(PW PUSan) E
AUTOS LL OWNED 0 SCHEDULED BouLY INJURY (ParSaidsn0 E
HIRED AUTOS (D PROPERTY DAMAGE S
UMBI E 25/50
uYERELLA LAB OCCUR EACH OCCURRENCE E
ncm imul CLAIMS40IADE AGGREGATE $
DED RETENTION S
MRNER3 COYIFIOIMON WCETATII- Ca
AND EMPLOYERS UABIUTY YIN CRY U
ANY PROPRIETORIPARTNERIENECUM1 EL EACH ACCIDENT S
OFFICERIMEMBER EXCLUDED? ~ NIA
(Wn&wq In NH) EL DISEASE - EA EMPL
=6=0 e
N OF OPERATIONS bebx EL DISEASE - POLICY UNIT S
DESCRPnON W OPERATIONS 1 LOCATIONS I VEHICLES (AUSeh ACORD 101, A kIhio W RwAz Schs I.1, M to apses N nw uhsd)
2002 Pool Windster 2PM 52422HE36330
•lo Day notice of cancellation in the even[ of nonpayment of premium.
certificate holder is listed as as additional insured.
CERTIFICATE HOLDER CANCELLATION
City of Ashland
20 East Main Stree SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Ashland, OR 97520 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WfTH THE POLICY PROVISIONS.
FAX 541-552-2059
AlRNO
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