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HomeMy WebLinkAboutInsurance Certificate: AccuSource ACCUS-1 OP ID: DR 'gill CERTIFICATE OF LIABILITY INSURANCE 0 DATE MMfDDNYYY) 05/06/13 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 909.435-0230 CONTACT NAME: Sawyer Cook Insurance 909-796-7971 NAME: FAX 1200 California St., Ste 250 AIC No Ext: A/C No Redlands, CA 92374 - E-MAIL Dawn Jeffrey ADDRESS: INSURERS AFFORDING COVERAGE NAIC re INSURER A: Maryland Casual 19356 INSURED AccuSource INSURER B: Preferred Employers Insurance Lianne Charton-Holder INSURER C: Travelers 36161 1240 E. Ontario Ave #102 -140 Corona, CA 92881 INSURER D: Houston Casual Company 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. INSR rypE OF INSURANCE POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDD/YYVV MM/DD/YYVY LIMITS ibma GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 A X COMMERCIAL GENERAL LIABILITY X PAS40515489 05123113 05123114 PREMISES Ea occurrence $ 2,000,000 CLAIMS-MADE rx-1 OCCUR MED EXP (Any one person) $ 10,00 PERSONAL B ADV INJURY $ exclude GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ 4,000,00 POLICY PRO LOG $ JFC.J AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS. AUTOS BODILY INJURY (Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Peraccitlenl UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY C ANY PROPRIETORMARTNERIEXECUTIVE YIN OFFICER/MEMBER EXCLUOED9 N/A UB9A424412 12120112 12120113 E.L. EACH ACCIDENT $ 1,000,00 ❑ (Mantlatory in NA) E.L. DISEASE - EA EMPLOYEE $ 1,000,00 If yes, de=ibe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,00 D Professional Liab H713100441 05/04113 05104114 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) 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. 20 East Main Street Ashland, OR 97520 AUT RR REPRESENTATIV D IT By ©1988.20 RPO ION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks r