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HomeMy WebLinkAboutInsurance Certificate: Tom Whisenant dba TLC Yellow Cab (2) A` °RO® CERTIFICATE OF LIABILITY INSURANCE °01103113""" 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 N0 E:CT Underwriting Dept. Tower Risk Management Corporation PHONE $00-417-4577 ac Ne : 954489-9389 a member of Tower Group Companies EMAiC. No Ea,. AIL 500 West Cypress Creek Road, Suite 500 ADDRESS: taxi@twrgrp.com Fort Lauderdale, FL 33309 INSURER(S) AFFORDING COVERAGE NAIC # Phone: (800) 4174577 Fax: (954) 489-9389 INSURERA: Preserver Insurance Company 15586 INSURED INSURER B: TOM WHISENANT D/B/A TLC YELLOW CAB INSURER C 278 IDAHO STREET #4 INSURER D : ASHLAND OR 97520 INSURER E: INSURER F 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 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. MISR ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMIDD MMID GENERAL LOBILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES Ea o=rrarce S CLAIMS-MADE ❑ OCCUR N N MED EXP (Any one person) $ PERSONAL B ADV INJURY $ GENERALAGGREGATE E GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGO E POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ed accident E 500,000 ANYAUTO 0Deductible BODILY INJURY (Per person) $ A AUTOWNED X AUTOSULED Y N BAPBZ0563513 113/2013 113/2014 BODILY INJURY (Perewdem) s NON,OWNED PROPERTY DAMAGE S HIREDAUTOS AUTOS Peracudeld $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR oc:MS MADE N N AGGREGATE $ DED RETENTIONS E WORKERS COMPENSATION VJCSTATU- OTH- R AND EMPLOYERS' LIABILITY YIN. _ ANY PROPRIETORIPARTNERIEXECUIVE ❑ NIA - E.L. EACH ACCIDENT E OFFICEIMEMBER EXCLUDEDi IMendelory In NH) E1 . DISEASE-EA EMPLOYE $ Il yea, deaWhe under E. L. DISEASE - POLICY LIMIT E A Uninsured Motorist Y N BAPBZ0563613 113/2013 1/3/2014 25,000/50,0001 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Ramerks Schedule, if more space is required) 20021 FORD / 2FMZA52422BB363371 CERTIFICATE HOLDER CANCELLATION CITY OF ASHLAND PUBLIC WORKS DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 E. MAIN STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ASHLAND OR 97520- ACCORDANCE WITH THE POLICY PROVISIONS. Additional Insured Fq F= G19 V II II AUTHORIZED REPRESENTATIVE ~ 4~ - 11 W JAN ZUIJ I i ; I ©1988-2010 A CORD CORP TION. All rights reserved. ACORD 25 (2010105) The ACORD name hdlaIs`o are registered marks of ACORD ~ ut