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HomeMy WebLinkAboutInsurance Certificate: Ross Recreation Equipment ROSSR-1 OP ID: LD Aco/20 CERTIFICATE OF LIABILITY INSURANCE 10/141201 O (MMIDDIYYYY) s 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 - CONTACT _Phone: 406-510-5440 NAME: Suhr.Risk Services ( Fax: 408-510-5490 PNDNE FAx 5300'Stevens •Creek Blvd. -"I - ac IN Eat: ' AIC NO: San JOse,.CA 95129 j E-MAIL _ Jeff State - House ADDRESS. - - - - - - - - INSURERS AFFORDING COVERAGE- NAIC A INSURER A: Admiral Insurance Company INSURED Ross Recreation Equipment INSURERS:QBE Insurance Company 11515 Company, Inc. INSURERC:Oak River Insurance Co. 100 Brush Creek Road, Ste 206 Santa Rosa, CA 95404 INSURER D: 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. LTR JADD INSR TYPE OF INSURANCE INSR MO II POLICY NUMBER MM/DDY/YYYY MMIDDY/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE - $ 1,000,00 ).A`' .'X' COMMERCIAL GENERAL LIABILITY X CA0000014701$ 10115/2013 1011$12014 DAMAGE PREMISES T RENT D Esorwnenca-- E - _ 50,00 ( r T CLAIMS-MADE FX OCCUR - - -MED EXP (Any one person)- E 5,000 ~ L r PERSONAC'8-ADV INJURY 1,000,00 - - - ~•'c.• ,J ' - - GENERAL-AGGREGATE--- .$._____.__,2,000,00C - R!i GEML-AGGREGATE LIMIT APPLIES.PER: "'PRODUCTS-COMP/OP AGO - . _ 2,000,00 r.N.':-. Poucr,' ,Loc.. . Emp Ben. , - s. - 1,000,00d Ea LIABILITY : - _ ,y COMBINED SINGLE LIMIT 1060,00- _ Ea accident B X ANYnUTO- PX810031 10/15/2013 10/15/2014 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS UTOS Per accident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE E EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION 8 $ WORKERS COMPENSATION X WCSTATU- OTH- AND EMPLOYERS' LIABILITY C ANY PROPRIETORIPARTNER/E%ECUTIVE YIN 2200014814131 1010112013 10/0112014 EL. EACH ACCIDENT Is 1,000,00 _ --I-OFHCER/S'EMeERE%CLUOEDV N;A _ _ ((Mandatory in NH) I EL. DISEASE -EAEMPLOYEE $ 1,000,00 If yes, desolde under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT 8 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) PW: The City of Ashland, Oregon, and its elected officials, officers and employees are named as additional insured per attached endorsement form CG2010. RE: Garfield Park CERTIFICATE HOLDER CANCELLATION CITYASH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland, Oregon THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN tY ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main Street Ashland, OR 97520 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Policy Number: CA00000147015 CG.,201007;04. Effective Date: 10/15/13 THIS ENDORSEMENT CHANCES.'fBE POLICY. PLEASE READ IT CARI';FULLY. ADDITIONAL INgURED - OWNER-S7 L SSEES 0.R, :CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies.insurance provided:under the following: COMMERCIAL GENERAL LIA 31LITIY COVERAGE'PART SCHEDULE . Name Of Additional Insured Person(s) OrOrganization(si: _ LOCadon(s):OfCovercdOeratious ANY PIMSON OR.ORGANLZATION MAT'IS AN OWNER ALL LOCATIONS OTHERWISE COVERED BY Or REAL PROPERTY OR PERSONAL PROPERTY ON THIS INSURANCE WHICH YOU ARE PERFORMING_ ONGOING OPERATIONS, ORA CONTRACTOR ON WHOSE BEHALF YOU,ARE. PERFORMING ONGOING OPERATIONS; BUT ONLY IF COVERAGE _AS.AN-ADDITIONAL INSURID.IS REQUIRED BY A WRITTEN: CONTRACT OR WRITTEN AGREENIENT THAT IS AN "INSITAIM CONTRACT'; AND PROVIDED THAT THE `BODILY IN URY",'TROPERTY DAMAGE"FOR "PERSONAL ANDXADVERTISING:INJURY" FIRST OCCURS SUBSEQUENT TO THE EXECUTION OF TI IE CONTRACT OR AGREEMENT.. Inforinalion rc aired locom-late thts.Schedule tfnotshown abovewill be slioivfr in the: Declarations. - A. Section 11- Who Is An Insured is aiuended to - This insurance does hot, apply to."bodily injury.'! or include-as an additional insured the person(s) or 'property.damage"occurring after: orgamzation(s).shawn in llic. Schedule; but only;wilh 1_ All woik, including materials;puts orequipment. respect to liability for "bodily injury", "property fumislicdnt connection wi0isuch work, on the damage" or "personal and, advertising injury" caused, project (other thau.service; maintenance or in whole air in part, by; repairs) to be. performed by or on behalf of the 1. Your acls..oromissions; or additional insured(s) at the location of the 2. 7h acts oromissiilm of those acting on your covered. operations has beeif completed; or Bclhalr; " - - '2. Tl afportion of'yourwork" our of Which the in die performance of your ongoing operations, for the; injury:or damagearises has been put to its additional insured(s)at drglocation(s) designated intended use by.any;persou or organtzaaon',oWer above. - than another contractor or subcontractor engaged. to performing operations for a principal as a; part B. Winonrespect to aah l in*su insuredsOle, , luirue following ng additional follo afforded olh of the same project. additional exclusions apply: CG 20 10'07:04 OISO Properties, Inc., 2004 Page l of l :p